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General NPI Number Information
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NPI Number | 1801110572
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Entity Type | Individual
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Provider Name | SUSAN PALMER DOLPHIN MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 503 N MAIN ST
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City | BELMONT
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State | NC
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Zip | 28012-3130
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Country | US
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Telephone | 704-648-7978
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Fax | 704-825-1413
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Provider Business Mailing Address
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Address Line | 9279 EGRET RDG
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City | BELMONT
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State | NC
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Zip | 28012-7636
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Country | US
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Telephone | 704-266-4400
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Fax | 704-266-4400
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LISW-CP 9302
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License Number State | SC
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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 | LCSW C005550
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW149008448 INACTI
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License Number State | IL
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