Doctor Name: | MRS. SUSAN BUSKILL FOGG |
NPI Number: | 1477889111 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 0701004695 |
Business Practice Address: | 19873 Riverside Drive Grundy, VA - 24614 |
Business Phone Number: | 2762104618 |
Business Fax Number: | |
Mailing Address: | Po Box 683, POUNDING MILL |
State: | VA |
Postal Code: | 246370683 |
Phone Number: | 2762104618 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2009 |
NPI Last Update Date: | 02/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701004695 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |