Provider Demographics
NPI:1598163719
Name:KUPPERS, SUSANNAH ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:ROSE
Last Name:KUPPERS
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 1:383 MERRIMON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1223
Mailing Address - Country:US
Mailing Address - Phone:828-775-5535
Mailing Address - Fax:828-544-1201
Practice Address - Street 1:383 MERRIMON AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1223
Practice Address - Country:US
Practice Address - Phone:828-775-5535
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0104051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical