Provider Demographics
NPI:1487824603
Name:SOUDERS, M SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:M
Middle Name:SUZANNE
Last Name:SOUDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 OAK LANE
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-436-3358
Mailing Address - Fax:804-435-9438
Practice Address - Street 1:113 DMV DRIVE
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-9237
Practice Address - Fax:804-435-9438
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker