Provider Demographics
NPI:1881974152
Name:SUSSER, ROBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:SUSSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 SUMMER GATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:980-233-8103
Mailing Address - Fax:
Practice Address - Street 1:800 BELLE TERRE PKWY. STE. 200 #161
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-3213
Practice Address - Country:US
Practice Address - Phone:843-810-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTV068.0064110101YM0800X
NJ37PC00231800101YM0800X
NY004725101YM0800X
101YM0800X
NH291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health