Provider Demographics
NPI:1093012924
Name:WALDEN, SUSAN B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:WALDEN
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 1:307 LAFAYETTE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6066
Mailing Address - Country:US
Mailing Address - Phone:540-479-1661
Mailing Address - Fax:540-479-1663
Practice Address - Street 1:307 LAFAYETTE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6066
Practice Address - Country:US
Practice Address - Phone:540-479-1661
Practice Address - Fax:540-479-1663
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional