Provider Demographics
NPI:1679042634
Name:STILL, SUSANNE STURDIVANT (LPC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:STURDIVANT
Last Name:STILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W JACKSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2310
Mailing Address - Country:US
Mailing Address - Phone:769-300-1443
Mailing Address - Fax:769-208-4477
Practice Address - Street 1:206 W JACKSON ST STE 100
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2310
Practice Address - Country:US
Practice Address - Phone:769-300-1443
Practice Address - Fax:769-208-4477
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional