Provider Demographics
NPI:1447546908
Name:MILLER, SUSAN ALEXANDER (LPC, LCAS-A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALEXANDER
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 SMOKE MONT DR APT 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5001
Mailing Address - Country:US
Mailing Address - Phone:336-707-2535
Mailing Address - Fax:
Practice Address - Street 1:1715 SHARON RD W
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5663
Practice Address - Country:US
Practice Address - Phone:704-944-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8560101YS0200X
NC8560323P00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility