Provider Demographics
NPI:1669702445
Name:PRESTON-JOSEY, SUSANNE ELIZABETH (PHD)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:ELIZABETH
Last Name:PRESTON-JOSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5505 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-472-4982
Mailing Address - Fax:757-282-5929
Practice Address - Street 1:5505 INDIAN RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-472-4982
Practice Address - Fax:757-282-5929
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004100101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701004100Medicaid