Basic Information
Provider Information
NPI: 1073004479
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTHET
FirstName: SUZANNE
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: LCMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 284 EXECUTIVE PARK DR STE 100
Address2:  
City: CONCORD
State: NC
PostalCode: 280251833
CountryCode: US
TelephoneNumber: 7049391100
FaxNumber: 7049391173
Practice Location
Address1: 101 COLVARD ST UNIT 1
Address2:  
City: JEFFERSON
State: NC
PostalCode: 286409797
CountryCode: US
TelephoneNumber: 3362464542
FaxNumber: 3362462364
Other Information
ProviderEnumerationDate: 05/22/2018
LastUpdateDate: 06/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X14082NCY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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