Provider Demographics
NPI:1891961181
Name:HULT, SUZANNE (A/D-AC PROV/TRAINEE)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:HULT
Suffix:
Gender:F
Credentials:A/D-AC PROV/TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13114 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2741
Mailing Address - Country:US
Mailing Address - Phone:240-313-3314
Mailing Address - Fax:240-313-3316
Practice Address - Street 1:13114 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2741
Practice Address - Country:US
Practice Address - Phone:240-313-3314
Practice Address - Fax:240-313-3316
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)