Healthcare Provider Details

I. General information

NPI: 1740078930
Provider Name (Legal Business Name): MINDSPIRE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

IV. Provider business mailing address

1009 N CALDWELL ST APT 1618
CHARLOTTE NC
28206-3599
US

V. Phone/Fax

Practice location:
  • Phone: 704-269-8933
  • Fax:
Mailing address:
  • Phone: 704-269-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NICOLE SUSKO
Title or Position: NURSE PRACTITIONER/ OWNER
Credential:
Phone: 704-269-8933