Provider Demographics
NPI:1801110572
Name:DOLPHIN, SUSAN PALMER (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PALMER
Last Name:DOLPHIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:DOLPHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:9279 EGRET RDG
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-7636
Mailing Address - Country:US
Mailing Address - Phone:704-266-4400
Mailing Address - Fax:704-266-4400
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3130
Practice Address - Country:US
Practice Address - Phone:704-648-7978
Practice Address - Fax:704-825-1413
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLISW-CP 9302101YM0800X
NCLCSW C005550101YM0800X
ILLCSW149008448 INACTI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health