Provider Demographics
NPI:1669059150
Name:ONGOMBE, SUSAN HAZEL
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HAZEL
Last Name:ONGOMBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 SLOPESIDE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-0001
Mailing Address - Country:US
Mailing Address - Phone:919-903-7168
Mailing Address - Fax:
Practice Address - Street 1:118 KRAMER CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6652
Practice Address - Country:US
Practice Address - Phone:919-633-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health