Provider Demographics
NPI:1669698445
Name:WHICHARD, SUSAN MICHELLE (PHD)
Entity type:Individual
Prefix:PROF
First Name:SUSAN
Middle Name:MICHELLE
Last Name:WHICHARD
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:2310 STINSON DR
Mailing Address - Street 2:ROOM 612 PSYCHOEDUCATIONAL CLINIC, NCSU
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-0001
Mailing Address - Country:US
Mailing Address - Phone:919-515-1713
Mailing Address - Fax:919-515-1716
Practice Address - Street 1:2310 STINSON DR
Practice Address - Street 2:RM 612, PSYCHOEDUCATIONAL CLINIC-NCSU
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-0001
Practice Address - Country:US
Practice Address - Phone:919-515-1713
Practice Address - Fax:919-515-1716
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2897103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool