Provider Demographics
NPI:1710362389
Name:OWENS, SUSANNA (PHD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 MCLAWS CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6347
Mailing Address - Country:US
Mailing Address - Phone:757-870-2266
Mailing Address - Fax:757-229-8937
Practice Address - Street 1:352 MCLAWS CIR STE 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6347
Practice Address - Country:US
Practice Address - Phone:757-870-2266
Practice Address - Fax:757-229-8937
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical