Provider Demographics
NPI:1366527087
Name:COONROD, SUSAN B (LPCC LICDC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:COONROD
Suffix:
Gender:F
Credentials:LPCC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MILLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9621
Mailing Address - Country:US
Mailing Address - Phone:330-717-3694
Mailing Address - Fax:
Practice Address - Street 1:3528 CANFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2779
Practice Address - Country:US
Practice Address - Phone:330-270-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981163101YA0400X
OHE0002342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health