Provider Demographics
NPI:1144450479
Name:GAYLORD, SUSAN RICHEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RICHEY
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357-0437
Mailing Address - Country:US
Mailing Address - Phone:910-494-5888
Mailing Address - Fax:910-426-3921
Practice Address - Street 1:162 SCHMIDT LN
Practice Address - Street 2:
Practice Address - City:LUMBER BRIDGE
Practice Address - State:NC
Practice Address - Zip Code:28357-9030
Practice Address - Country:US
Practice Address - Phone:910-494-5888
Practice Address - Fax:910-426-3921
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical