Provider Demographics
NPI:1235747908
Name:HAKEEM, SUSAN GAYLE (LMHC-T)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAYLE
Last Name:HAKEEM
Suffix:
Gender:F
Credentials:LMHC-T
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:GAYLE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9628 PROSPECT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2933
Mailing Address - Country:US
Mailing Address - Phone:512-947-1469
Mailing Address - Fax:
Practice Address - Street 1:9628 PROSPECT AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2933
Practice Address - Country:US
Practice Address - Phone:512-947-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0212111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health