Provider Demographics
NPI:1104120872
Name:THOMPSON, SUSAN MARTHA (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARTHA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COMMERCIAL ST. SUITES G & H
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-8003
Mailing Address - Country:US
Mailing Address - Phone:570-352-4997
Mailing Address - Fax:
Practice Address - Street 1:61 COMMERCIAL ST SUITES G & H
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-8003
Practice Address - Country:US
Practice Address - Phone:570-352-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC005700OtherPROFESSIONAL COUNSELOR LICENSE