Provider Demographics
NPI:1831467091
Name:SISLER, SUSAN LESLIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LESLIE
Last Name:SISLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:MEHERRIN
Mailing Address - State:VA
Mailing Address - Zip Code:23954-0035
Mailing Address - Country:US
Mailing Address - Phone:434-390-2044
Mailing Address - Fax:
Practice Address - Street 1:689 PRICE GEE DR
Practice Address - Street 2:
Practice Address - City:MEHERRIN
Practice Address - State:VA
Practice Address - Zip Code:23954
Practice Address - Country:US
Practice Address - Phone:434-390-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005096101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional