Provider Demographics
NPI:1750809554
Name:LEA, SUSAN (LMFT, CAMSII)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LEA
Suffix:
Gender:F
Credentials:LMFT, CAMSII
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W SAINT JOHN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5157
Mailing Address - Country:US
Mailing Address - Phone:864-406-5774
Mailing Address - Fax:864-778-2983
Practice Address - Street 1:101 W SAINT JOHN ST STE 103
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5157
Practice Address - Country:US
Practice Address - Phone:864-406-5774
Practice Address - Fax:864-778-2983
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC7000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCS1520281Medicaid