Provider Demographics
NPI:1104297076
Name:SABATINI, SUSAN JEAN (NC #11008A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:SABATINI
Suffix:
Gender:F
Credentials:NC #11008A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5634 STRAWBERRY HILL DR
Mailing Address - Street 2:APT A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4670
Mailing Address - Country:US
Mailing Address - Phone:704-577-2747
Mailing Address - Fax:
Practice Address - Street 1:10801 JOHNSTON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4558
Practice Address - Country:US
Practice Address - Phone:704-577-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11008A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist