Provider Demographics
NPI:1699740118
Name:HUELSBECK, MARY SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUE
Last Name:HUELSBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:HUELSBECK
Other - Last Name:SIBRACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:629 OBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1126
Mailing Address - Country:US
Mailing Address - Phone:919-781-9657
Mailing Address - Fax:
Practice Address - Street 1:629 OBERLIN ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:919-781-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical