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General NPI Number Information
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NPI Number | 1174103543
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Entity Type | Organization
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Legal Business Name | SUSAN LEA, LLC
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Dates
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Enumeration Date | 04/10/2021
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 101 W ST JOHN ST SUITE 103
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City | SPARTANBURG
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State | SC
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Zip | 29306
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Country | US
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Telephone | 864-406-5774
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Fax | 864-778-2983
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Provider Business Mailing Address
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Address Line | 101 W ST JOHN ST SUITE 103
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City | SPARTANBURG
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State | SC
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Zip | 29306
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Country | US
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Telephone | 864-406-5774
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Fax | 864-778-2983
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Authorized Official
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Title or Position | OWNER AND PRINCIPAL
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Name | MS. SUSAN LEA
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Credential | LMFT, CAMS II
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Telephone | 864-406-5774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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