Provider Demographics
NPI:1295145431
Name:WEEKS, SUSAN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WEEKS
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 1:4500 I-55 NORTH, HIGHLAND VILLAGE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5931
Mailing Address - Country:US
Mailing Address - Phone:601-201-0148
Mailing Address - Fax:
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-201-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS12629403OtherCAQH