Provider Demographics
NPI:1629525324
Name:JEFFERSON MORTON, SUSAN MICHELE (LPC, RPT, NCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELE
Last Name:JEFFERSON MORTON
Suffix:
Gender:F
Credentials:LPC, RPT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MARY ALICE PARK RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2664
Mailing Address - Country:US
Mailing Address - Phone:301-213-1368
Mailing Address - Fax:
Practice Address - Street 1:102 MARY ALICE PARK RD
Practice Address - Street 2:SUITE 504
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2664
Practice Address - Country:US
Practice Address - Phone:301-213-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007830101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor