Provider Demographics
NPI:1386419125
Name:MOFFITT, SUSAN MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1992
Mailing Address - Country:US
Mailing Address - Phone:602-566-7627
Mailing Address - Fax:844-610-6047
Practice Address - Street 1:3800 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1992
Practice Address - Country:US
Practice Address - Phone:602-566-7627
Practice Address - Fax:844-610-6047
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ88510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty