Suzanne Mactaggart Medlin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C006559 Issued in NC

Practice address

3541 Randolph Rd
Suite 206
Charlotte, NC 28211-1082

Phone

(704) 381-8336

Fax

(704) 381-8332

NPI assigned

Apr 25, 2011

Last updated

Jun 12, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1215228390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601372",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601372",
            "telephone_number": "704-381-8336",
            "fax_number": "704-381-8332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 RANDOLPH RD",
            "address_2": "SUITE 206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111082",
            "telephone_number": "704-381-8336",
            "fax_number": "704-381-8332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLIN",
        "first_name": "SUZANNE",
        "middle_name": "MACTAGGART",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-25",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006559",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "C006559",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6009037",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Medley, LPC
• Kevin Medley
• Michtorie Medley
• Kathleen Lane Medlin, CCC-SLP
• Michael James Medlin, RBT
• Medrehab Specialists of North Carolina, PA
• Medris, LLC
• Medsite Health Management
• Medstreamline LLC
• Medswift Couriers LLC (MedSwift Couriers)

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.