Provider Demographics
NPI:1417328956
Name:SUBER, SYLVESTER KERRY (LPC)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:KERRY
Last Name:SUBER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 TWISTED OAK CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9761
Mailing Address - Country:US
Mailing Address - Phone:803-944-7200
Mailing Address - Fax:
Practice Address - Street 1:612 TWISTED OAK CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-9761
Practice Address - Country:US
Practice Address - Phone:803-944-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health