Basic Information
| Provider Information | |||||||||
| NPI: | 1235288622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAM | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LPA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAM | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | WALTON | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A., LPA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 673 COVINGTON DR NW | ||||||||
| Address2: | |||||||||
| City: | CALABASH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284671893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102876962 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 63 STAMP ACT DRIVE | ||||||||
| Address2: | |||||||||
| City: | BOLIVIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102534485 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | LPA#3133 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.