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General NPI Number Information
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NPI Number | 1861698144
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Entity Type | Individual
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Provider Name | SUSAN HUBER SULLIVAN MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 407 W WARREN ST
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City | SHELBY
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State | NC
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Zip | 28150-5329
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Country | US
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Telephone | 704-487-9325
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Fax | 704-487-9314
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Provider Business Mailing Address
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Address Line | 352 CAPE BRETON TRIL
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City | GASTONIA
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State | NC
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Zip | 28056-8355
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Country | US
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Telephone | 704-487-9325
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Fax | 704-487-9314
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3532
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License Number State | NC
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