Provider Demographics
NPI:1407435563
Name:DR SUSAN ZONNEBELT-SMEENGE LICENSED CLINICAL PSYCHOLOGIST
Entity Type:Organization
Organization Name:DR SUSAN ZONNEBELT-SMEENGE LICENSED CLINICAL PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ZONNEBELT-SMEENGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EDD
Authorized Official - Phone:616-780-1082
Mailing Address - Street 1:1413 GROVEHURST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6180
Mailing Address - Country:US
Mailing Address - Phone:616-780-1082
Mailing Address - Fax:
Practice Address - Street 1:1413 GROVEHURST DRIVE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6180
Practice Address - Country:US
Practice Address - Phone:616-780-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty