Provider Demographics
NPI:1063236859
Name:SUH, JANE (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1249 HATCHLAND PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-7747
Mailing Address - Country:US
Mailing Address - Phone:310-702-4563
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR STE 200
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8512
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:703-552-1948
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903003352104100000X
VA09040177111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker