| Doctor Name: | MRS. SUSAN LYNN DIMOCK |
| NPI Number: | 1619098167 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | L3672 |
| Business Practice Address: | 1212 Alabama St Suite 27 Bandon, OR - 97411 |
| Business Phone Number: | 5413477090 |
| Business Fax Number: | |
| Mailing Address: | Po Box 252, BANDON |
| State: | OR |
| Postal Code: | 974110252 |
| Phone Number: | 5413477090 |
| Fax Number: | |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | L3672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |