Provider Demographics
NPI:1316322324
Name:AICH, SUSANNA LORRAINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:LORRAINE
Last Name:AICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SOUTHLAND CT
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6262
Mailing Address - Country:US
Mailing Address - Phone:501-391-2793
Mailing Address - Fax:
Practice Address - Street 1:915 OAK ST STE 103
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4389
Practice Address - Country:US
Practice Address - Phone:501-725-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AR8424-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health