Provider Demographics
NPI:1437171212
Name:DIETERICH, SUSAN A (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:DIETERICH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31571 SCHWARTZ RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3760
Mailing Address - Country:US
Mailing Address - Phone:440-892-0452
Mailing Address - Fax:440-892-3472
Practice Address - Street 1:24551 DETROIT RD
Practice Address - Street 2:STE 5
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2592
Practice Address - Country:US
Practice Address - Phone:440-892-0452
Practice Address - Fax:440-892-3472
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0006694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional