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General NPI Number Information
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NPI Number | 1558767442
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Entity Type | Individual
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Provider Name | SUSAN BLANK LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY NE STE 330
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City | ATLANTA
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State | GA
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Zip | 30328-4274
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Country | US
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Telephone | 404-256-2277
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Fax | 404-250-0025
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Provider Business Mailing Address
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Address Line | 284 S MAIN ST SUITE 800
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City | ALPHARETTA
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State | GA
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Zip | 30009-7904
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Country | US
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Telephone | 678-575-4315
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Fax | 404-250-0025
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC007811
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License Number State | GA
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