Provider Demographics
NPI:1497839732
Name:HERBERG, SUZANNE BROOKS (LPC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:BROOKS
Last Name:HERBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 TAPESTRY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3617
Mailing Address - Country:US
Mailing Address - Phone:703-209-3545
Mailing Address - Fax:703-978-7547
Practice Address - Street 1:4614 TAPESTRY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3617
Practice Address - Country:US
Practice Address - Phone:703-209-3545
Practice Address - Fax:703-978-7547
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945247Medicaid
VA210245OtherBLUE CROSS BLUE SHIELD
VA004978277Medicaid