Provider Demographics
NPI:1083964316
Name:SOUKUP, KARLA SUE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:SUE
Last Name:SOUKUP
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EAKIN ST SW
Mailing Address - Street 2:
Mailing Address - City:BLACKBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-808-3828
Mailing Address - Fax:
Practice Address - Street 1:510 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLACKBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-951-1311
Practice Address - Fax:540-851-1566
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist