Provider Demographics
NPI:1588836852
Name:CLARK, SUZANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11285 ELKINS RD
Mailing Address - Street 2:D-4
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1259
Mailing Address - Country:US
Mailing Address - Phone:770-377-4958
Mailing Address - Fax:770-521-0512
Practice Address - Street 1:11285 ELKINS RD
Practice Address - Street 2:D-4
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1259
Practice Address - Country:US
Practice Address - Phone:770-377-4958
Practice Address - Fax:770-521-0512
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional