Provider Demographics
NPI:1225073323
Name:LAMP, SUSAN C (MS, LCSW, CCAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:LAMP
Suffix:
Gender:F
Credentials:MS, LCSW, CCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 25TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2809
Mailing Address - Country:US
Mailing Address - Phone:304-428-1984
Mailing Address - Fax:
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:304-485-1478
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV94-304101YA0400X
WVCP00450536104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV94-304OtherADDICTION COUNSELOR CERT
WVCP00450436OtherSOCIAL WORK LICENSE
WV94-304OtherADDICTION COUNSELOR CERT