Provider Demographics
NPI:1558576397
Name:MASSEY, SUANNE TANEAL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUANNE
Middle Name:TANEAL
Last Name:MASSEY
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 1:9407 CUMBERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2029
Mailing Address - Country:US
Mailing Address - Phone:804-966-2242
Mailing Address - Fax:804-966-5639
Practice Address - Street 1:9407 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2029
Practice Address - Country:US
Practice Address - Phone:804-966-2242
Practice Address - Fax:804-966-5639
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046901041C0700X
WYLCSW2281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical