Provider Demographics
NPI:1619022142
Name:MATHEWS-DUVALL, SUSAN SLATE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SLATE
Last Name:MATHEWS-DUVALL
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:PO BOX 21016
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0103
Mailing Address - Country:US
Mailing Address - Phone:859-227-9998
Mailing Address - Fax:
Practice Address - Street 1:3959 ELECTRIC RD STE 210
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4507
Practice Address - Country:US
Practice Address - Phone:540-206-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002539103TC1900X
KYKY-1482103TC1900X
VA0810006100103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling