Provider Demographics
NPI:1639558885
Name:HART STEPHENS, SUSANNAH MARGARET (LICSW, SUDP)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:MARGARET
Last Name:HART STEPHENS
Suffix:
Gender:F
Credentials:LICSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18490 SUQUAMISH WAY NE
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-9532
Mailing Address - Country:US
Mailing Address - Phone:360-394-8558
Mailing Address - Fax:360-598-1724
Practice Address - Street 1:18490 SUQUAMISH WAY NE
Practice Address - Street 2:
Practice Address - City:SUQUAMISH
Practice Address - State:WA
Practice Address - Zip Code:98392-9532
Practice Address - Country:US
Practice Address - Phone:360-394-8558
Practice Address - Fax:360-598-1724
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60672681101YA0400X
WALW61492248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206507Medicaid