Doctor Name: | SUSAN CHILD |
NPI Number: | 1902076862 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH6826 |
Business Practice Address: | 12030 Sw 76th Ter Lake Butler, FL - 320545546 |
Business Phone Number: | 3863441266 |
Business Fax Number: | 8663412063 |
Mailing Address: | 12030 Sw 76th Ter, LAKE BUTLER |
State: | FL |
Postal Code: | 320545546 |
Phone Number: | 3863441266 |
Fax Number: | 8663412063 |
NPI Enumeration Date: | 03/06/2008 |
NPI Last Update Date: | 03/06/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6826 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |