Provider Demographics
NPI:1003073412
Name:WACHTER, SUSAN (MA, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WACHTER
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. SYBELIA AVENUE
Mailing Address - Street 2:SUITE # 165
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-963-1034
Mailing Address - Fax:
Practice Address - Street 1:100 E. SYBELIA AVENUE
Practice Address - Street 2:SUITE # 165
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-963-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health