Provider Demographics
NPI:1720816598
Name:VELLA, SUZANNE (LMHC-A)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:VELLA
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 REDCLIFF DR APT M
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3864
Mailing Address - Country:US
Mailing Address - Phone:315-720-2006
Mailing Address - Fax:
Practice Address - Street 1:8209 VILLAGE HARBOR DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-3706
Practice Address - Country:US
Practice Address - Phone:704-255-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health