Provider Demographics
NPI:1356433502
Name:OSHRY, SUSANNE GWYNN (LPC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:GWYNN
Last Name:OSHRY
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 1:5205-A LYNGATE COURT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2428
Mailing Address - Country:US
Mailing Address - Phone:571-233-2135
Mailing Address - Fax:
Practice Address - Street 1:5205 LYNGATE CT STE A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1693
Practice Address - Country:US
Practice Address - Phone:571-233-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003063103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling