Provider Demographics
NPI:1891926309
Name:CESSNA, SUNDRA M (LPC)
Entity Type:Individual
Prefix:
First Name:SUNDRA
Middle Name:M
Last Name:CESSNA
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 1:9052 HWY429
Mailing Address - Street 2:
Mailing Address - City:SALLIS
Mailing Address - State:MS
Mailing Address - Zip Code:39160
Mailing Address - Country:US
Mailing Address - Phone:540-840-5951
Mailing Address - Fax:
Practice Address - Street 1:9052 HWY 429
Practice Address - Street 2:
Practice Address - City:SALLIS
Practice Address - State:MS
Practice Address - Zip Code:39160
Practice Address - Country:US
Practice Address - Phone:540-840-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1891929309OtherNPPES
VA004945247Medicaid
VAC02810OtherMEDICARE
VA1891926309OtherNPI