Provider Demographics
NPI:1245521962
Name:GLOVER, SUSAN LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:GLOVER
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 1:2411 E FRANKLIN ST
Mailing Address - Street 2:APT 212
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7879
Mailing Address - Country:US
Mailing Address - Phone:804-249-2979
Mailing Address - Fax:
Practice Address - Street 1:5267 GREENWICH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6028
Practice Address - Country:US
Practice Address - Phone:757-552-0884
Practice Address - Fax:757-552-0887
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional