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General NPI Number Information
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NPI Number | 1558758276
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Entity Type | Individual
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Provider Name | SUSAN KORNETT MA, LPCA, LCASA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 111 WINDEL DR SUITE 205
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City | RALEIGH
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State | NC
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Zip | 27609-4475
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Country | US
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Telephone | 919-915-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 SASSWOOD LN
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City | ZEBULON
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State | NC
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Zip | 27597-2158
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Country | US
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Telephone | 919-915-5933
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-20769
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A11256
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License Number State | NC
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