Provider Demographics
NPI:1699836809
Name:CREAGER, JOETTE RANDALL (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JOETTE
Middle Name:RANDALL
Last Name:CREAGER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2906
Mailing Address - Country:US
Mailing Address - Phone:843-881-1558
Mailing Address - Fax:
Practice Address - Street 1:890 JOHNNIE DODDS BLVD
Practice Address - Street 2:BLDG. C
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3105
Practice Address - Country:US
Practice Address - Phone:843-224-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional