Provider Demographics
NPI:1013086388
Name:GIDDINGS, SUSAN O (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:O
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:N
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 N LYNNHAVEN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-486-6955
Mailing Address - Fax:757-486-3258
Practice Address - Street 1:101 N LYNNHAVEN RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-486-6955
Practice Address - Fax:757-486-3258
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAANTHEMOther088607
800002931Medicare PIN