Individual
ANGELA WYNONNA SUSILO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHCA
Contact information
Practice address
3210 SHOREWOOD DR APT 145, MERCER ISLAND, WA 98040-3224
(331) 444-9206
Mailing address
3210 SHOREWOOD DR APT 145, MERCER ISLAND, WA 98040-3224
(331) 444-9206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MC61094941
WA
Other
Enumeration date
07/28/2021
Last updated
08/14/2021
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