Provider Demographics
NPI:1275969248
Name:WALSH, SUSAN LANI (LPC, MAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LANI
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC, MAC
Other - Prefix:MS
Other - First Name:LANI
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, MAC
Mailing Address - Street 1:1993 N DECATUR RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1158
Mailing Address - Country:US
Mailing Address - Phone:678-427-8543
Mailing Address - Fax:404-320-9478
Practice Address - Street 1:1993 N DECATUR RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1158
Practice Address - Country:US
Practice Address - Phone:678-427-8543
Practice Address - Fax:404-320-9478
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002039101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health