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General NPI Number Information
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NPI Number | 1316665938
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Entity Type | Individual
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Provider Name | SADATREYA TANESHA MOULTRIE LPC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 560 CHRIS DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4669
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Country | US
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Telephone | 803-791-9422
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Fax | 803-828-9647
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Provider Business Mailing Address
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Address Line | 560 CHRIS DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4669
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Country | US
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Telephone | 80-379-1942
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Fax | 803-828-9647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9479
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9479
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License Number State | SC
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