Provider Demographics
NPI:1417526476
Name:FRY, SUZANNE (LPC, NCC, BC-TMH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:LPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-2007
Mailing Address - Country:US
Mailing Address - Phone:888-301-8354
Mailing Address - Fax:888-301-1492
Practice Address - Street 1:463 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-2007
Practice Address - Country:US
Practice Address - Phone:304-645-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health