Provider Demographics
NPI:1659128080
Name:BOAK, SUZANNE ELIZABETH (LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:BOAK
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 ASHLEY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9334
Mailing Address - Country:US
Mailing Address - Phone:313-770-6846
Mailing Address - Fax:
Practice Address - Street 1:279 ASHLEY WOODS CT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9334
Practice Address - Country:US
Practice Address - Phone:313-770-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064436104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool