Provider Demographics
NPI:1053658211
Name:MORRISON, SUSAN RENEA (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEA
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROWN OAKS CTR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6166
Mailing Address - Country:US
Mailing Address - Phone:843-514-2123
Mailing Address - Fax:407-260-1634
Practice Address - Street 1:100 CROWN OAKS CTR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6166
Practice Address - Country:US
Practice Address - Phone:843-514-2123
Practice Address - Fax:407-260-1634
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist