1497969950 NPI number — SUZANNE NICOLE STANGLAND MA, LPC

Table of content: SUZANNE NICOLE STANGLAND MA, LPC (NPI 1497969950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497969950 NPI number — SUZANNE NICOLE STANGLAND MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANGLAND
Provider First Name:
SUZANNE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497969950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 OGLETHORPE PROFESSIONAL BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-352-7638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1481 DEAN FOREST RD
Provider Second Line Business Practice Location Address:
SUITE 200A
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-9342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-667-5848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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