Provider Demographics
NPI:1619383072
Name:SUSAN MYERS, LCSW INC
Entity Type:Organization
Organization Name:SUSAN MYERS, LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-275-6789
Mailing Address - Street 1:338 COEBURN AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-2606
Mailing Address - Country:US
Mailing Address - Phone:276-275-6789
Mailing Address - Fax:276-679-2174
Practice Address - Street 1:338 COEBURN AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-2606
Practice Address - Country:US
Practice Address - Phone:276-275-6789
Practice Address - Fax:276-679-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040015491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty