Provider Demographics
NPI:1386872638
Name:GOLDMAN, SUSAN ALLEN (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ALLEN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELLA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:959 MILLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2312
Mailing Address - Country:US
Mailing Address - Phone:703-759-3314
Mailing Address - Fax:
Practice Address - Street 1:1400 SPRING ROAD,NW 20010
Practice Address - Street 2:L.H. PSYCHOLOGICAL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-506-3575
Practice Address - Fax:202-506-3587
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional