Provider Demographics
NPI:1447862388
Name:GUIRAGOSS, SUZANNE A
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:GUIRAGOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44330 PREMIER PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5071
Mailing Address - Country:US
Mailing Address - Phone:703-340-8936
Mailing Address - Fax:866-929-9306
Practice Address - Street 1:44330 PREMIER PLZ STE 100
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5071
Practice Address - Country:US
Practice Address - Phone:703-340-8936
Practice Address - Fax:866-929-9306
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704012843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty