Provider Demographics
NPI:1942823901
Name:BLOUNT, SUZETT DELICIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUZETT
Middle Name:DELICIA
Last Name:BLOUNT
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 1:3595 HIRAM DOUGLASVILLE HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4963
Mailing Address - Country:US
Mailing Address - Phone:678-250-6026
Mailing Address - Fax:
Practice Address - Street 1:3595 HIRAM DOUGLASVILLE HWY STE 108
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4963
Practice Address - Country:US
Practice Address - Phone:678-250-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC011523OtherLICENSE