1073554093 NPI number — MRS. SUSAN BELL YORK L.C.S.W.

Table of content: MRS. SUSAN BELL YORK L.C.S.W. (NPI 1073554093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073554093 NPI number — MRS. SUSAN BELL YORK L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YORK
Provider First Name:
SUSAN
Provider Middle Name:
BELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL
Provider Other First Name:
SUSAN
Provider Other Middle Name:
HARRIS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073554093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 DRAKE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-512-6985
Provider Business Mailing Address Fax Number:
910-270-4546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 LAKESIDE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNEADS FERRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-512-6985
Provider Business Practice Location Address Fax Number:
910-270-4546
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  C000476 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C000476 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6002137 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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