Provider Demographics
NPI:1245380294
Name:PEREIRA, SUZANNE M (PHDC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:PHDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-5347
Mailing Address - Country:US
Mailing Address - Phone:209-823-1556
Mailing Address - Fax:
Practice Address - Street 1:8626 LOWER SACRAMENTO RD STE 41
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1835
Practice Address - Country:US
Practice Address - Phone:209-478-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)