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NPI Code Detail

MEDICARE: SUSANNAH COUCH LCSW

MEDICARE: SUSANNAH COUCH LCSW
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
11041C0700XClinical Social WorkerCSW009325GA

General Provider Information

NPI Number : 1396565420
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANNAH COUCH LCSW
Provider Business Mailing Address
First Line : 1681 FLAT ROCK RD
Second Line :
City : WATKINSVILLE
State : GA
Zip : 30677-3110
Country : US
Telephone Number : 706-308-1537
Fax Number :
Provider Business Practice Location Address
First Line : 675 PULASKI ST STE 1400
Second Line :
City : ATHENS
State : GA
Zip : 30601-2384
Country : US
Telephone Number : 706-308-1537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2024
Last Update Date : 10/14/2024

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Directions to “ SUSANNAH COUCH LCSW” Practice Location

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