Provider Demographics
NPI:1972868768
Name:MATTOX, SUSAN LYNNE (LPC,LCAS,CRC-MAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNNE
Last Name:MATTOX
Suffix:
Gender:F
Credentials:LPC,LCAS,CRC-MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 UNION CROSS RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6448
Mailing Address - Country:US
Mailing Address - Phone:336-784-9470
Mailing Address - Fax:336-784-9505
Practice Address - Street 1:1931 UNION CROSS RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6448
Practice Address - Country:US
Practice Address - Phone:336-784-9470
Practice Address - Fax:336-784-9505
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional