Provider Demographics
NPI:1750147708
Name:COLLIER, SUSAN DIANE
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:MARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:13915 COUNTRYSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAUGANSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21767
Mailing Address - Country:US
Mailing Address - Phone:240-346-3093
Mailing Address - Fax:
Practice Address - Street 1:13915 COUNTRYSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:MAUGANSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21767
Practice Address - Country:US
Practice Address - Phone:240-346-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD075351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical