Provider Demographics
NPI:1396256624
Name:KIDD, SUZANNA (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:KIDD
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 1:301 E WENDOVER AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1231
Mailing Address - Country:US
Mailing Address - Phone:336-832-3070
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 310
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1231
Practice Address - Country:US
Practice Address - Phone:336-832-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical