Basic Information
| Provider Information | |||||||||
| NPI: | 1942372156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRBY | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | OAKLEY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2013 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6000036 | 05 | NC | MEDICAID | 0364A | 01 | NC | BCBS | OTHER |