Provider Demographics
NPI:1033850177
Name:RHOADS, SUSANNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:ELIZABETH
Last Name:RHOADS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 RUSKIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3550
Mailing Address - Country:US
Mailing Address - Phone:407-782-7864
Mailing Address - Fax:
Practice Address - Street 1:263 RUSKIN ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3550
Practice Address - Country:US
Practice Address - Phone:407-782-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health