Healthcare Provider Details

I. General information

NPI: 1609597756
Provider Name (Legal Business Name): SUZANNE MARIE MORAVICK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 SHOPTON DR
APEX NC
27502-4595
US

IV. Provider business mailing address

3103 SHOPTON DR
APEX NC
27502-4595
US

V. Phone/Fax

Practice location:
  • Phone: 914-248-5911
  • Fax:
Mailing address:
  • Phone: 914-248-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: