Provider Demographics
NPI:1134446685
Name:ROUSEY, SUSAN L (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:ROUSEY
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:ROUSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1811 SARDIS RD N
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1426
Mailing Address - Country:US
Mailing Address - Phone:704-814-4677
Mailing Address - Fax:704-845-6111
Practice Address - Street 1:1811 SARDIS RD N
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1426
Practice Address - Country:US
Practice Address - Phone:704-814-4677
Practice Address - Fax:704-845-6111
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS8862101YM0800X
NC8862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104938Medicaid