Healthcare Provider Details

I. General information

NPI: 1598163719
Provider Name (Legal Business Name): SUSANNAH ROSE KUPPERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MERRIMON AVE STE C
ASHEVILLE NC
28801-1223
US

IV. Provider business mailing address

383 MERRIMON AVE STE C
ASHEVILLE NC
28801-1223
US

V. Phone/Fax

Practice location:
  • Phone: 828-775-5535
  • Fax: 828-544-1201
Mailing address:
  • Phone: 828-775-5535
  • Fax: 828-544-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: