Provider Demographics
NPI:1508890047
Name:MYERS, SUSANNE WILLOUGHBY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:WILLOUGHBY
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSANNE
Other - Middle Name:MURIEL
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1401 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4913
Mailing Address - Country:US
Mailing Address - Phone:205-510-2761
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:1401 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4913
Practice Address - Country:US
Practice Address - Phone:205-510-2761
Practice Address - Fax:205-510-2790
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1936C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537397OtherBCBS FEDERAL EMPLOYEE PRO
AL51535365OtherBLUE CROSS OF AL
AL630288854OtherAMERICAN BEHAVIORAL HEALT
AL51537397OtherBCBS FEDERAL EMPLOYEE PRO