Provider Demographics
NPI:1336778604
Name:JETER, LANITRA FAYE
Entity type:Individual
Prefix:MRS
First Name:LANITRA
Middle Name:FAYE
Last Name:JETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 LIVE OAK TRCE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-1876
Mailing Address - Country:US
Mailing Address - Phone:205-876-7782
Mailing Address - Fax:
Practice Address - Street 1:2330 HIGHLAND AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2912
Practice Address - Country:US
Practice Address - Phone:205-447-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional