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General NPI Number Information
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NPI Number | 1063469922
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Entity Type | Individual
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Provider Name | SUSAN M ULMER LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4000 BLUE RIDGE RD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27612-4650
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Country | US
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Telephone | 919-785-9710
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Fax | 919-782-4429
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Provider Business Mailing Address
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Address Line | 2824 SANDIA DR
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City | RALEIGH
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State | NC
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Zip | 27607-3150
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Country | US
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Telephone | 919-785-9710
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Fax | 919-782-4429
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C003119
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License Number State | NC
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