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General NPI Number Information
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NPI Number | 1063576684
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH FUNK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 501 S SHARON AMITY RD STE 500
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City | CHARLOTTE
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State | NC
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Zip | 28211-2897
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Country | US
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Telephone | 704-655-7544
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Fax |
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Provider Business Mailing Address
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Address Line | 6907 ROLLINGRIDGE DR
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City | CHARLOTTE
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State | NC
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Zip | 28211-5466
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Country | US
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Telephone | 724-464-7745
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3818
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License Number State | NC
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