Provider Demographics
NPI:1669498705
Name:PERZ, SUSAN M (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PERZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5387 RABBIT FARM RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4246
Mailing Address - Country:US
Mailing Address - Phone:770-519-0002
Mailing Address - Fax:
Practice Address - Street 1:4460 ATLANTA HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7313
Practice Address - Country:US
Practice Address - Phone:770-519-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist