Provider Demographics
NPI:1184627614
Name:TROXLER, SUSIE OZETTA (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:OZETTA
Last Name:TROXLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSIE
Other - Middle Name:OZETTA
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 41105
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-1105
Mailing Address - Country:US
Mailing Address - Phone:336-324-1610
Mailing Address - Fax:
Practice Address - Street 1:3409 W WENDOVER AVE STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1579
Practice Address - Country:US
Practice Address - Phone:336-324-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045R4OtherBLUE CROSS BLUE SHIELD
NC6000363Medicaid
NC045R4OtherBLUE CROSS BLUE SHIELD