Provider Demographics
NPI:1831734722
Name:ALTHISAR, SUDIE SUMMERS (LMFT)
Entity type:Individual
Prefix:
First Name:SUDIE
Middle Name:SUMMERS
Last Name:ALTHISAR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BREMO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2440
Mailing Address - Country:US
Mailing Address - Phone:804-282-8332
Mailing Address - Fax:
Practice Address - Street 1:2000 BREMO RD STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2440
Practice Address - Country:US
Practice Address - Phone:804-282-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist