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Angela Wynonna Susilo, LMHCA
Mental Health Counselor in Mercer Island, Washington
NPI 1831862598

Angela Wynonna Susilo is a Mental Health Counselor based in Mercer Island, WA and is specialized in Mental Health. Angela Wynonna Susilo practices in Mercer Island, WA and has the professional credentials of LMHCA. The NPI Number for Angela Wynonna Susilo is 1831862598 and holds a License No. MC61094941 (Washington).

The current practice location address for Angela Wynonna Susilo is 3210 Shorewood Dr Apt 145, Mercer Island, WA and can be reached out via phone at 331-444-9206.

Location: 3210 Shorewood Dr Apt 145, Mercer Island, WA, 98040-3224
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1831862598
Provider Name
Angela Wynonna Susilo
Credential
LMHCA
Provider Entity Type
Individual
Gender
Female
Address
3210 Shorewood Dr Apt 145, Mercer Island, WA, 98040-3224
Phone Number
331-444-9206
Fax Number
Provider Enumeration Date
07/28/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3210 Shorewood Dr Apt 145
City
Mercer Island
State
Washington
Zip
98040-3224
Phone Number
331-444-9206
Fax Number
person
Provider Business Mailing Address Details
Address
3210 Shorewood Dr Apt 145
City
Mercer Island
State
Washington
Zip
98040-3224
Phone Number
331-444-9206
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
MC61094941 (Washington)
Definition
Definition to come...
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