Provider Demographics
NPI:1174718068
Name:KEENAN, SUSAN L (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 COPPER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4310
Mailing Address - Country:US
Mailing Address - Phone:678-825-8217
Mailing Address - Fax:
Practice Address - Street 1:655 COPPER CREEK CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4310
Practice Address - Country:US
Practice Address - Phone:678-825-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003161101Y00000X
NC53620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor