Provider Demographics
NPI:1720609258
Name:BLACKWOOD, SUZANNE NORMAND (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:NORMAND
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1525
Mailing Address - Country:US
Mailing Address - Phone:931-723-0380
Mailing Address - Fax:931-723-0358
Practice Address - Street 1:104 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1525
Practice Address - Country:US
Practice Address - Phone:931-723-0380
Practice Address - Fax:931-723-0358
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health