Provider Demographics
NPI:1609931971
Name:HAMMONDS-WHITE, SUSAN ELISABETH (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELISABETH
Last Name:HAMMONDS-WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELISABETH
Other - Last Name:HAMMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2416 21ST AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5318
Mailing Address - Country:US
Mailing Address - Phone:615-386-0313
Mailing Address - Fax:
Practice Address - Street 1:2416 21ST AVE S STE 204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5318
Practice Address - Country:US
Practice Address - Phone:615-386-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3115144OtherBCBS PIN#