Provider Demographics
NPI:1174689327
Name:DRISCOLL, SUSAN QUEENEY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:QUEENEY
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 JUDGE PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3129
Mailing Address - Country:US
Mailing Address - Phone:301-869-6724
Mailing Address - Fax:
Practice Address - Street 1:19510 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3002
Practice Address - Country:US
Practice Address - Phone:301-977-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health