Provider Demographics
NPI:1518263854
Name:STUBBS, SUSIE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:C
Last Name:STUBBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 CODORUS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1100
Mailing Address - Country:US
Mailing Address - Phone:410-300-2367
Mailing Address - Fax:
Practice Address - Street 1:1188 CODORUS ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-1100
Practice Address - Country:US
Practice Address - Phone:410-300-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health