Healthcare Provider Details

I. General information

NPI: 1912264581
Provider Name (Legal Business Name): SUZANNE DERBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CORPORATE DR STE 301
HILLSBOROUGH NC
27278-8560
US

IV. Provider business mailing address

960 CORPORATE DR STE 301
HILLSBOROUGH NC
27278-8560
US

V. Phone/Fax

Practice location:
  • Phone: 919-428-3833
  • Fax:
Mailing address:
  • Phone: 919-428-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016236
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: