Provider Demographics
NPI:1417705880
Name:THOMAS, SUSANNE (MA)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S TELEGRAPH RD # L231
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0241
Mailing Address - Country:US
Mailing Address - Phone:269-389-0432
Mailing Address - Fax:
Practice Address - Street 1:2510 S TELEGRAPH RD # L231
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0241
Practice Address - Country:US
Practice Address - Phone:269-389-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional