Provider Demographics
NPI:1861698144
Name:SULLIVAN, SUSAN HUBER (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HUBER
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 CAPE BRETON TRIL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8355
Mailing Address - Country:US
Mailing Address - Phone:704-487-9325
Mailing Address - Fax:704-487-9314
Practice Address - Street 1:407 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5329
Practice Address - Country:US
Practice Address - Phone:704-487-9325
Practice Address - Fax:704-487-9314
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional