MEDICARE: SUANDRIA HOUSTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	TPMC2002	FL
2	101YP2500X	Professional Counselor	LPC.018191	CO
3	101YP2500X	Professional Counselor	LPC014867	GA

General Provider Information

NPI Number	:	1033632815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUANDRIA HOUSTON LPC

Provider Business Mailing Address
First Line	:	3466 HOLLOW STREAM TRL
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5317
Country	:	US
Telephone Number	:	720-772-6967
Fax Number	:

Provider Business Practice Location Address
First Line	:	3466 HOLLOW STREAM TRL
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5317
Country	:	US
Telephone Number	:	720-772-6967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	02/26/2026

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