Healthcare Provider Details

I. General information

NPI: 1730408543
Provider Name (Legal Business Name): SUZANNE WUNDER TIMMS LCSW; LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 S BERKELEY LAKE RD # B
NORCROSS GA
30071-1639
US

IV. Provider business mailing address

4530 S BERKELEY LAKE RD # B
NORCROSS GA
30071-1639
US

V. Phone/Fax

Practice location:
  • Phone: 770-417-2753
  • Fax: 770-446-5643
Mailing address:
  • Phone: 770-417-2753
  • Fax: 770-446-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number352
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number688
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: