Angela Wynonna Susilo, LMHCA

NPI #1831862598 in Mercer Island, Washington

Provider Information

NPI Number: 1831862598
Entity Type: Individual
Name: Angela Wynonna Susilo, LMHCA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Credential: LMHCA
Enumeration Date: Jul 28, 2021
Last Updated: Aug 14, 2021

Practice Location

Address: 3210 SHOREWOOD DR APT 145
City: Mercer Island
State: Washington
ZIP Code: 98040-3224
Phone: (331) 444-9206

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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