Provider Demographics
NPI:1215751060
Name:KLEIN, SUZANNE E (MS, CRC, RIC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS, CRC, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 STONELEIGH RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-4405
Mailing Address - Country:US
Mailing Address - Phone:434-422-2071
Mailing Address - Fax:877-363-9068
Practice Address - Street 1:PO BOX 962
Practice Address - Street 2:
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477-0962
Practice Address - Country:US
Practice Address - Phone:540-490-4440
Practice Address - Fax:877-363-9068
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017488101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0704017488OtherVA BOARD OF COUNSELING