Provider Demographics
NPI:1972977502
Name:WHITNEY, SUSAN (RRT, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:RRT, LMHC, NCC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:HARBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:1970 BROOKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6674
Mailing Address - Country:US
Mailing Address - Phone:321-312-7359
Mailing Address - Fax:
Practice Address - Street 1:1970 BROOKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6674
Practice Address - Country:US
Practice Address - Phone:321-312-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001343227900000X
FLMH22734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered