Provider Demographics
NPI:1881806701
Name:ARCENEAUX, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ARCENEAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10438 EDWIN LADNER RD
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-9289
Mailing Address - Country:US
Mailing Address - Phone:601-709-1253
Mailing Address - Fax:
Practice Address - Street 1:1900 N WEST ST
Practice Address - Street 2:SUTIE D
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1033
Practice Address - Country:US
Practice Address - Phone:601-709-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC66451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07374544Medicaid