Provider Demographics
NPI:1316665938
Name:MOULTRIE, SADATREYA TANESHA (LPC)
Entity type:Individual
Prefix:
First Name:SADATREYA
Middle Name:TANESHA
Last Name:MOULTRIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 CHRIS DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4669
Mailing Address - Country:US
Mailing Address - Phone:080-379-1942
Mailing Address - Fax:803-828-9647
Practice Address - Street 1:560 CHRIS DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4669
Practice Address - Country:US
Practice Address - Phone:803-791-9422
Practice Address - Fax:803-828-9647
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9479101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health