Provider Demographics
NPI:1972731503
Name:DEVALL, SUE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:DEVALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-4993
Mailing Address - Country:US
Mailing Address - Phone:304-620-7036
Mailing Address - Fax:
Practice Address - Street 1:1149 RIDGE RD N
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-4993
Practice Address - Country:US
Practice Address - Phone:304-620-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker