Provider Demographics
NPI:1932534401
Name:WHITE, SUSAN HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HARRIS
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:HARRIS
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD COUNSELING
Mailing Address - Street 1:130 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-9735
Mailing Address - Country:US
Mailing Address - Phone:606-337-2449
Mailing Address - Fax:
Practice Address - Street 1:130 DOGWOOD TRL
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-9735
Practice Address - Country:US
Practice Address - Phone:606-269-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral