Provider Demographics
NPI:1194741306
Name:BEREL, SUSAN RACHEL (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RACHEL
Last Name:BEREL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RACHEL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1827 POWERS FERRY RD.
Mailing Address - Street 2:BLDG. 22
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-953-4744
Mailing Address - Fax:770-953-4640
Practice Address - Street 1:3860 WINDERMERE PARKWAY
Practice Address - Street 2:BLDG. 203
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:770-953-4640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical