Provider Demographics
NPI:1245873595
Name:HERRING, SUSAN VICKERY (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VICKERY
Last Name:HERRING
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 1:107 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7125
Mailing Address - Country:US
Mailing Address - Phone:601-259-8424
Mailing Address - Fax:
Practice Address - Street 1:1151 N STATE ST STE 212
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2467
Practice Address - Country:US
Practice Address - Phone:601-352-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional