Provider Demographics
NPI:1487013249
Name:THOMPSON, SUZAN K (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2328
Mailing Address - Country:US
Mailing Address - Phone:757-569-9357
Mailing Address - Fax:
Practice Address - Street 1:1008 OLD VIRGINIA BEACH RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5564
Practice Address - Country:US
Practice Address - Phone:757-422-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional