Basic Information
Provider Information
NPI: 1245400373
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUNRO
FirstName: SUSAN
MiddleName: HELEN
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2245 STANTONSBURG RD
Address2: SUITE P
City: GREENVILLE
State: NC
PostalCode: 278342868
CountryCode: US
TelephoneNumber: 2527520483
FaxNumber: 2527522971
Practice Location
Address1: 2115 FOREST HILLS RD W STE A
Address2:  
City: WILSON
State: NC
PostalCode: 278933483
CountryCode: US
TelephoneNumber: 2522371037
FaxNumber: 2522372190
Other Information
ProviderEnumerationDate: 03/05/2008
LastUpdateDate: 03/05/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XC003546NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home