Provider Demographics
NPI:1316132277
Name:LOFTIS, SUSAN D (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:LOFTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:44 TRIFECTA PL
Mailing Address - Street 2:STE 205
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5720
Mailing Address - Country:US
Mailing Address - Phone:304-728-3716
Mailing Address - Fax:304-728-3740
Practice Address - Street 1:1419 FOREST DR
Practice Address - Street 2:SUITE # 205
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1482
Practice Address - Country:US
Practice Address - Phone:443-254-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD055811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical