Provider Demographics
NPI:1912416520
Name:CLIFFORD, SUSAN LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4094 GOODMAN CROSSING
Mailing Address - Street 2:P.O. BOX 52
Mailing Address - City:LYNCH STATION
Mailing Address - State:VA
Mailing Address - Zip Code:24571
Mailing Address - Country:US
Mailing Address - Phone:434-426-5572
Mailing Address - Fax:
Practice Address - Street 1:1045 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540
Practice Address - Country:US
Practice Address - Phone:434-835-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA013300137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst