Provider Demographics
NPI:1669555850
Name:HARRIS, SUSAN NEELEY (LPC,LMFT,CAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NEELEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC,LMFT,CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15941 DONALD CURTIS DR
Mailing Address - Street 2:200
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4256
Mailing Address - Country:US
Mailing Address - Phone:703-792-4905
Mailing Address - Fax:703-792-5699
Practice Address - Street 1:7969 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2885
Practice Address - Country:US
Practice Address - Phone:703-792-4943
Practice Address - Fax:703-792-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002676101YM0800X
VA0717000715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA210245OtherBLUE CROSS BLUE SHIELD
VA210245OtherBLUE CROSS BLUE SHIELD