Provider Demographics
NPI:1154482305
Name:MCCONNELL, SUSAN B (LPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 AIRPORT BLVD
Mailing Address - Street 2:BLDG B STE 200
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6768
Mailing Address - Country:US
Mailing Address - Phone:251-342-4707
Mailing Address - Fax:251-342-4724
Practice Address - Street 1:6576 AIRPORT BLVD
Practice Address - Street 2:BLDG B STE 200
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6768
Practice Address - Country:US
Practice Address - Phone:251-342-4707
Practice Address - Fax:251-342-4724
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPT 945101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor