Provider Demographics
NPI:1740675198
Name:GRISWOLD, SUZANNE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 MILL ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2542
Mailing Address - Country:US
Mailing Address - Phone:404-723-5407
Mailing Address - Fax:
Practice Address - Street 1:3155 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2542
Practice Address - Country:US
Practice Address - Phone:404-723-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional