Provider Demographics
NPI:1699807230
Name:ELLIOTT, SUSAN CARTER (LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CARTER
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2626
Mailing Address - Country:US
Mailing Address - Phone:203-453-4320
Mailing Address - Fax:
Practice Address - Street 1:2 GRAVES AVE
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2626
Practice Address - Country:US
Practice Address - Phone:203-453-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000101101YA0400X
CT000149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)