Provider Demographics
NPI:1568638070
Name:ABRAHAM, SUSANNAH LAYNE (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:LAYNE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7473
Mailing Address - Country:US
Mailing Address - Phone:614-985-5500
Mailing Address - Fax:
Practice Address - Street 1:130 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-7473
Practice Address - Country:US
Practice Address - Phone:614-985-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional