Healthcare Provider Details

I. General information

NPI: 1609391234
Provider Name (Legal Business Name): DR. SUSIE O. TROXLER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 W WENDOVER AVE STE E
GREENSBORO NC
27407-1525
US

IV. Provider business mailing address

PO BOX 41105
GREENSBORO NC
27404-1105
US

V. Phone/Fax

Practice location:
  • Phone: 336-324-1610
  • Fax: 800-699-7219
Mailing address:
  • Phone: 336-324-1610
  • Fax: 800-699-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2790
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSIE OZETTA TROXLER
Title or Position: OWNER
Credential: PHD
Phone: 336-324-1610