Provider Demographics
NPI:1588094247
Name:EBELING-WITTE, SUSAN (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:EBELING-WITTE
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 1:115 LLOYD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7218
Mailing Address - Country:US
Mailing Address - Phone:732-330-6339
Mailing Address - Fax:
Practice Address - Street 1:236 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7585
Practice Address - Country:US
Practice Address - Phone:732-330-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00475500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health