Provider Demographics
NPI:1811506207
Name:BOUCHER, SUSAN MARISA (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARISA
Last Name:BOUCHER
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 1:3925 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5730
Mailing Address - Country:US
Mailing Address - Phone:251-316-0060
Mailing Address - Fax:
Practice Address - Street 1:3925 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5730
Practice Address - Country:US
Practice Address - Phone:251-316-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health