Provider Demographics
NPI:1316665938
Name:MOULTRIE, SADATREYA TANESHA (LPC-A)
Entity type:Individual
Prefix:
First Name:SADATREYA
Middle Name:TANESHA
Last Name:MOULTRIE
Suffix:
Gender:
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7755
Mailing Address - Country:US
Mailing Address - Phone:803-520-9370
Mailing Address - Fax:
Practice Address - Street 1:1633 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7755
Practice Address - Country:US
Practice Address - Phone:803-520-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health