Provider Demographics
NPI:1386944536
Name:FITZHUGH, SUZZETTE MARDELL (LLPC)
Entity type:Individual
Prefix:MRS
First Name:SUZZETTE
Middle Name:MARDELL
Last Name:FITZHUGH
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18209 HUBBELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2770
Mailing Address - Country:US
Mailing Address - Phone:313-320-2763
Mailing Address - Fax:
Practice Address - Street 1:18209 HUBBELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2770
Practice Address - Country:US
Practice Address - Phone:313-320-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional