Provider Demographics
NPI:1356718027
Name:KILLAM, SUSAN GRACE (CESP, CWIC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRACE
Last Name:KILLAM
Suffix:
Gender:F
Credentials:CESP, CWIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PALM TER
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4735
Mailing Address - Country:US
Mailing Address - Phone:504-812-7276
Mailing Address - Fax:504-556-7574
Practice Address - Street 1:411 S. PRIEUR ST
Practice Address - Street 2:HUMAN DEVELOPMENT CENTER
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-556-7588
Practice Address - Fax:504-556-7574
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor