Provider Demographics
NPI:1194037556
Name:MAEHRE, SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MAEHRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 REGENCY ROW SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-3540
Mailing Address - Country:US
Mailing Address - Phone:706-844-8112
Mailing Address - Fax:
Practice Address - Street 1:120 REGENCY ROW SW
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3540
Practice Address - Country:US
Practice Address - Phone:706-844-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005034101YP2500X
UT6231195-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional