Individual
SUSSANNIE LUCYNDA DA COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CRC,PSYD (ABD)
Contact information
Practice address
1525 MAIN AVE, SAINT MARIES, ID 83861-1216
(208) 717-1782
Mailing address
1525 MAIN AVE, SAINT MARIES, ID 83861-1216
(208) 717-1782
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
CA
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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