Provider Demographics
NPI:1306559091
Name:MACDONALD, SUZANNE MARIE (LPC, LLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LPC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26555 EVERGREEN RD STE 830
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4239
Mailing Address - Country:US
Mailing Address - Phone:248-350-3650
Mailing Address - Fax:248-350-1216
Practice Address - Street 1:26555 EVERGREEN RD STE 830
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4239
Practice Address - Country:US
Practice Address - Phone:248-350-3650
Practice Address - Fax:248-350-1216
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional