Healthcare Provider Details

I. General information

NPI: 1568435535
Provider Name (Legal Business Name): SUSAN MARY UNDERHILL MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 OLEANDER DR STE 103
WILMINGTON NC
28403-6800
US

IV. Provider business mailing address

4020 OLEANDER DR STE 103
WILMINGTON NC
28403-6800
US

V. Phone/Fax

Practice location:
  • Phone: 910-218-8295
  • Fax: 910-240-6595
Mailing address:
  • Phone: 910-218-8295
  • Fax: 910-240-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11433
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004020675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: