Provider Demographics
NPI:1235489246
Name:MACLANE, SUSAN C (LPC, CEAP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:MACLANE
Suffix:
Gender:F
Credentials:LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 N UPSHUR ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4060
Mailing Address - Country:US
Mailing Address - Phone:703-528-4125
Mailing Address - Fax:703-528-1744
Practice Address - Street 1:2506 N UPSHUR ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-4060
Practice Address - Country:US
Practice Address - Phone:703-528-4125
Practice Address - Fax:703-528-1744
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health