Provider Demographics
NPI:1740462068
Name:FENTRESS, SUZANNE HARTNESS (LISW-CP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:HARTNESS
Last Name:FENTRESS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:HARTNESS
Other - Last Name:FENTRESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:955 W WADE HAMPTON BLVD STE 4B
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1296
Mailing Address - Country:US
Mailing Address - Phone:864-905-6835
Mailing Address - Fax:864-334-5046
Practice Address - Street 1:955 W WADE HAMPTON BLVD STE 4B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-905-6835
Practice Address - Fax:864-334-5046
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68531041C0700X
OK42301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical