Provider Demographics
NPI:1346381324
Name:STREETER, JOHN W (LPC, NCC, CAAT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:STREETER
Suffix:
Gender:M
Credentials:LPC, NCC, CAAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-0672
Mailing Address - Country:US
Mailing Address - Phone:304-876-9258
Mailing Address - Fax:304-876-9258
Practice Address - Street 1:236 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3331
Practice Address - Country:US
Practice Address - Phone:304-263-8522
Practice Address - Fax:304-263-8559
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional