Provider Demographics
NPI:1710294905
Name:SUMTER, LORETTA JENKINS (MSW)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:JENKINS
Last Name:SUMTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 JEFFERSON AVENUE EXT BLDG 786
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6049
Mailing Address - Country:US
Mailing Address - Phone:843-764-7418
Mailing Address - Fax:843-764-7529
Practice Address - Street 1:1005 JEFFERSON AVENUE EXT BLDG 786
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6049
Practice Address - Country:US
Practice Address - Phone:843-764-7418
Practice Address - Fax:843-764-7529
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010774381041C0700X
SC35741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical