Provider Demographics
NPI:1356473607
Name:MARINO, SUSAN ARMSTRONG (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ARMSTRONG
Last Name:MARINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RAYL ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2328
Mailing Address - Country:US
Mailing Address - Phone:574-774-5747
Mailing Address - Fax:573-774-5427
Practice Address - Street 1:1400 STATE ROAD F
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-512-0742
Practice Address - Fax:573-774-5427
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional