Provider Demographics
NPI:1841851037
Name:HOLLAND, SUSAN SCOTT (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SCOTT
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 BUCKNER RD SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2705
Mailing Address - Country:US
Mailing Address - Phone:404-434-7057
Mailing Address - Fax:
Practice Address - Street 1:701 WHITLOCK AVE SW STE J45
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4658
Practice Address - Country:US
Practice Address - Phone:470-344-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional