Provider Demographics
NPI:1841256112
Name:WILSON, SUZANNE S (MA, LPC/MHSP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WARD CIR
Mailing Address - Street 2:SUITE B-21
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7518
Mailing Address - Country:US
Mailing Address - Phone:615-373-0443
Mailing Address - Fax:
Practice Address - Street 1:229 WARD CIR
Practice Address - Street 2:SUITE B-21
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7518
Practice Address - Country:US
Practice Address - Phone:615-373-0443
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001440101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional