Provider Demographics
NPI:1376873398
Name:WEBER, SUE ANN (PH D, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:PH D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 DUPONT STATION CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2567
Mailing Address - Country:US
Mailing Address - Phone:904-394-5751
Mailing Address - Fax:904-448-0349
Practice Address - Street 1:6261 DUPONT STATION CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2567
Practice Address - Country:US
Practice Address - Phone:904-394-5751
Practice Address - Fax:904-448-0349
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZMH8614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health