Provider Demographics
NPI:1720426836
Name:VANNOY, SUSAN HERZOG (MA, LMFT, LCAS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HERZOG
Last Name:VANNOY
Suffix:
Gender:F
Credentials:MA, LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938B W KING ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3467
Mailing Address - Country:US
Mailing Address - Phone:828-270-7835
Mailing Address - Fax:
Practice Address - Street 1:938B W KING ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3467
Practice Address - Country:US
Practice Address - Phone:828-270-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2505101YA0400X
NC1505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)