Provider Demographics
NPI:1770655169
Name:FROST, SUSAN ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:FROST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAMPTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3512
Mailing Address - Country:US
Mailing Address - Phone:757-865-1843
Mailing Address - Fax:757-865-7485
Practice Address - Street 1:205 HAMPTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3512
Practice Address - Country:US
Practice Address - Phone:757-865-1843
Practice Address - Fax:757-865-7485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8922071Medicaid
VA8922071Medicaid
VA800009511Medicare ID - Type Unspecified