Provider Demographics
NPI:1003902693
Name:NIEDENTHAL, SUSAN ADAMS (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ADAMS
Last Name:NIEDENTHAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4802
Mailing Address - Country:US
Mailing Address - Phone:757-466-3336
Mailing Address - Fax:757-455-5750
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4802
Practice Address - Country:US
Practice Address - Phone:757-466-3336
Practice Address - Fax:757-455-5750
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003228101YP2500X
VA0701003288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5413010Medicaid
VA005413010Medicaid