Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0701003288 | VA |
N | 101YP2500X | Professional Counselor | 0701003228 | VA |
NPI | 1003902693 |
---|---|
Provider Name | Ms. Susan Adams Niedenthal |
First Address | Norfolk, VA 23502-4802 |
Second Address | Norfolk, VA 23502-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 17/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005413010 | (05) | VA |
5413010 | (05) | VA |