Provider Demographics
NPI:1477724243
Name:RATHMELL, SUSAN RENEAU (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RENEAU
Last Name:RATHMELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 URBAN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2594
Mailing Address - Country:US
Mailing Address - Phone:205-983-4063
Mailing Address - Fax:
Practice Address - Street 1:1952 URBAN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35242-2594
Practice Address - Country:US
Practice Address - Phone:205-983-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical