Provider Demographics
NPI:1154652873
Name:FRAILING-SALTISIAK, SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:FRAILING-SALTISIAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:FRAILING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10109 KRAUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6501
Mailing Address - Country:US
Mailing Address - Phone:804-751-8644
Mailing Address - Fax:
Practice Address - Street 1:10109 KRAUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6501
Practice Address - Country:US
Practice Address - Phone:804-751-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical