Provider Demographics
NPI:1013537935
Name:NGUYEN, SUONG ANH (LMSW)
Entity type:Individual
Prefix:
First Name:SUONG
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3505 W CLARK RD APT J203
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9430
Mailing Address - Country:US
Mailing Address - Phone:616-635-8457
Mailing Address - Fax:
Practice Address - Street 1:3505 W CLARK RD APT J203
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9430
Practice Address - Country:US
Practice Address - Phone:616-635-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011191651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical