Provider Demographics
NPI:1487815486
Name:ZACHARIAS, SUSAN FLORENCE (LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FLORENCE
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21620 W EMPRESS LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6318
Mailing Address - Country:US
Mailing Address - Phone:757-784-6022
Mailing Address - Fax:
Practice Address - Street 1:21620 W EMPRESS LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-6318
Practice Address - Country:US
Practice Address - Phone:757-784-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011955101YP2500X
VA0717001236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist