Provider Demographics
NPI:1477892743
Name:DECKER, SUSAN ROMAINE (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROMAINE
Last Name:DECKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ROMAINE
Other - Last Name:KUHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:270 SUSQUEHANNA VALLEY MALL DR STE 100
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9115
Practice Address - Country:US
Practice Address - Phone:708-847-9225
Practice Address - Fax:570-768-4195
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034236670003Medicaid