Provider Demographics
NPI:1396499729
Name:WOOD, SUSANNA H (MS, MED, LPC)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:H
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SCHOOLHOUSE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-9900
Mailing Address - Country:US
Mailing Address - Phone:540-588-2854
Mailing Address - Fax:
Practice Address - Street 1:40 COMMERCE LN STE D
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:VA
Practice Address - Zip Code:22738-4009
Practice Address - Country:US
Practice Address - Phone:540-588-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional