Individual provider Active NPI

Susan Morgan Stork, LCPC, NCC

  • Counselor
  • Baltimore, MD
National Provider Identifier
1952785586
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LC6380 Issued in MD
Practice address
1501 Sulgrave Ave Ste 200a
Baltimore, MD 21209-4595
Phone
(443) 527-2042
NPI assigned
Jul 14, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LC6380 MD
Counselor 101Y00000X LC6380 MD Primary

Addresses

Primary practice location

1501 Sulgrave Ave Ste 200a
Baltimore, MD 21209-4595

Mailing address

1501 Sulgrave Ave Ste 200a
Baltimore, MD 21209-4595
Phone (443) 527-2042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LC6380MDMDCommunity/Behavioral Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Space Between Counseling Services, LLC Counselor CurrentSince Aug 11, 2019 Accepting new patients

Locations

1501 Sulgrave Ave
Ste 200A
Baltimore, MD 21209
Phone (410) 206-4665

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1952785586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 200A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212094595",
            "telephone_number": "443-527-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 200A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212094595",
            "telephone_number": "443-527-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORK",
        "first_name": "SUSAN",
        "middle_name": "MORGAN",
        "credential": "LCPC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MD",
            "license": "LC6380",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MD",
            "license": "LC6380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; 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.