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Individual
MRS. SUSAN W MOODY
Active
Individual
MRS. SUSAN W MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC, RPT
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000247A
IN
1041C0700X
Clinical Social Worker
Primary
34005092A
IN
Other
Enumeration date
08/30/2006
Last updated
07/21/2022
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