Provider Demographics
NPI:1679649537
Name:GARVEY, SUSAN CHRISTINE (MA, LPA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:GARVEY
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 DUDLEYS GRANT DR APT E
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8362
Mailing Address - Country:US
Mailing Address - Phone:252-916-6291
Mailing Address - Fax:
Practice Address - Street 1:127 OAKMONT DR # A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5937
Practice Address - Country:US
Practice Address - Phone:252-353-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107383Medicaid