Provider Demographics
NPI:1417980624
Name:PEAVY, JODI M (LISW-CP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:PEAVY
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:SUMPTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3588 CROSSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7594
Mailing Address - Country:US
Mailing Address - Phone:843-399-3807
Mailing Address - Fax:
Practice Address - Street 1:3588 CROSSCREEK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7594
Practice Address - Country:US
Practice Address - Phone:843-222-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0071551041C0700X
SC158551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical