Provider Demographics
NPI:1700228293
Name:SUSAN JOA DBA REFLECTIONS
Entity Type:Organization
Organization Name:SUSAN JOA DBA REFLECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:386-717-6134
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-0244
Mailing Address - Country:US
Mailing Address - Phone:386-717-6134
Mailing Address - Fax:
Practice Address - Street 1:217 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3209
Practice Address - Country:US
Practice Address - Phone:386-717-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty