Provider Demographics
NPI:1700146784
Name:JARVIS, SADIE D (LPC LPCS)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:D
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LPC LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 BELLEVILLE ROAD NE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115
Mailing Address - Country:US
Mailing Address - Phone:803-535-5285
Mailing Address - Fax:
Practice Address - Street 1:2841 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-2149
Practice Address - Country:US
Practice Address - Phone:803-535-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional