Provider Demographics
NPI:1306477476
Name:CHIRCO, SUSANNE PAULINE (MS, CRC, CAADC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:PAULINE
Last Name:CHIRCO
Suffix:
Gender:F
Credentials:MS, CRC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3392
Mailing Address - Country:US
Mailing Address - Phone:931-296-9813
Mailing Address - Fax:931-295-9853
Practice Address - Street 1:795 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3392
Practice Address - Country:US
Practice Address - Phone:931-296-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN-062101YA0400X
ILCRC0024686101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional