Provider Demographics
NPI:1710416631
Name:MCGILLOWAY, SUSAN (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCGILLOWAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HOLLING PL UNIT 407
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5062
Mailing Address - Country:US
Mailing Address - Phone:172-680-8584
Mailing Address - Fax:
Practice Address - Street 1:1301 HOLLING PL UNIT 407
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5062
Practice Address - Country:US
Practice Address - Phone:172-680-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262557101YP2500X
MDLC12959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional