Provider Demographics
NPI:1982639332
Name:SUSKIEWICH, LOTTIE M (LMHC)
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:M
Last Name:SUSKIEWICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 1ST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1270
Mailing Address - Country:US
Mailing Address - Phone:407-302-1774
Mailing Address - Fax:
Practice Address - Street 1:312 W 1ST ST STE 107
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1270
Practice Address - Country:US
Practice Address - Phone:407-302-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health