Provider Demographics
NPI:1396813093
Name:JETER, SUSANNE SALVO (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:SALVO
Last Name:JETER
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 OLD TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6004
Mailing Address - Country:US
Mailing Address - Phone:843-852-5259
Mailing Address - Fax:843-852-5259
Practice Address - Street 1:27 GAMECOCK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6004
Practice Address - Country:US
Practice Address - Phone:843-852-5259
Practice Address - Fax:843-852-5259
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional