Provider Demographics
NPI:1922380799
Name:O'NEILL, SUE BURDETTE (LPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:BURDETTE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:SUE
Other - Last Name:BURDETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88154 HIGHWAY 9
Mailing Address - Street 2:PO POX 366
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-6932
Mailing Address - Country:US
Mailing Address - Phone:256-276-1451
Mailing Address - Fax:256-396-5977
Practice Address - Street 1:59468 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-4769
Practice Address - Country:US
Practice Address - Phone:256-276-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL150101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3390-19041OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - COOSA COUNTY
AL3390-58050OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - ST. CLAIR COUNTY
AL3390-08171OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - CALHOUN COUNTY
AL3390-14038OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - CLAY COUNTY
AL3390-56039OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - RANDOLPH COUNTY
AL3390-15030OtherSTATE OF ALABAMA MEDICAID PARTICIPANT NUMBER - CLEBURNE COUNTY