Provider Demographics
NPI:1164637971
Name:HART, SUSAN LADONNA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LADONNA
Last Name:HART
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 1:2905 COATBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4110
Mailing Address - Country:US
Mailing Address - Phone:205-515-6595
Mailing Address - Fax:
Practice Address - Street 1:2905 COATBRIDGE LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4110
Practice Address - Country:US
Practice Address - Phone:205-515-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health