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General NPI Number Information
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NPI Number | 1881974152
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Entity Type | Individual
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Provider Name | ROBIN SUSSER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 800 BELLE TERRE PKWY. STE. 200 #161
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City | PALM COAST
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State | FL
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Zip | 32164-3213
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Country | US
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Telephone | 843-810-4083
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Fax |
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Provider Business Mailing Address
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Address Line | 5108 SUMMER GATE DRIVE
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City | CHARLOTTE
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State | NC
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Zip | 28226
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Country | US
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Telephone | 980-233-8103
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | V068.0064110
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License Number State | VT
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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 | 37PC00231800
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License Number State | NJ
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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 | 004725
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 291
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License Number State | NH
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