Provider Demographics
NPI:1720679194
Name:ABBAS, SUSETTE (LPCC)
Entity Type:Individual
Prefix:
First Name:SUSETTE
Middle Name:
Last Name:ABBAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:SUSETTE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:4604 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5107
Mailing Address - Country:US
Mailing Address - Phone:310-698-2802
Mailing Address - Fax:
Practice Address - Street 1:4604 W 131ST ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5107
Practice Address - Country:US
Practice Address - Phone:310-698-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC1003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional