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General NPI Number Information
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NPI Number | 1366842379
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Entity Type | Individual
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Provider Name | SUZANNE ANDERSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR STE 510
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8207
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Country | US
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Telephone | 904-376-3800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 748519
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City | ATLANTA
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State | GA
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Zip | 30374-8519
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Country | US
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Telephone | 904-376-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT4488
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201877
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License Number State | TX
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