Provider Demographics
NPI:1912065384
Name:JONES, SUSANNE E (LPC)
Entity Type:Individual
Prefix:MISS
First Name:SUSANNE
Middle Name:E
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SUSANNE
Other - Middle Name:JONES
Other - Last Name:FORDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2020 SABA DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 EAST HOSPITAL ROAD
Practice Address - Street 2:ROOM 13A-10
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-5620
Practice Address - Fax:706-787-3143
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005077101YP2500X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional