Provider Demographics
NPI:1679828511
Name:GOMOLA, SUSAN LINDA (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:GOMOLA
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 1:91 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2958
Mailing Address - Country:US
Mailing Address - Phone:814-952-2009
Mailing Address - Fax:814-938-2728
Practice Address - Street 1:91 PICKETT RD
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2958
Practice Address - Country:US
Practice Address - Phone:814-952-2009
Practice Address - Fax:814-938-2728
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC 002698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health