Provider Demographics
NPI:1992980809
Name:MAREAN, SUSAN COOPER (CDP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:COOPER
Last Name:MAREAN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 PORT STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-8403
Mailing Address - Country:US
Mailing Address - Phone:360-468-2114
Mailing Address - Fax:
Practice Address - Street 1:520 SPRING ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8057
Practice Address - Country:US
Practice Address - Phone:360-378-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00045742101Y00000X
WACP00005142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor