Provider Demographics
NPI:1265532998
Name:BOYER, SUSAN HAWKINS (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HAWKINS
Last Name:BOYER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1600
Mailing Address - Country:US
Mailing Address - Phone:248-613-9090
Mailing Address - Fax:248-601-9991
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-613-9090
Practice Address - Fax:248-601-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1201000446OtherCERT # ALLIED HEALTH