Provider Demographics
NPI:1467296640
Name:SUBER, NATLIE SHANEIVA
Entity type:Individual
Prefix:MRS
First Name:NATLIE
Middle Name:SHANEIVA
Last Name:SUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATLIE
Other - Middle Name:SHANEIVA
Other - Last Name:LANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 GENTLE BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29805-7589
Mailing Address - Country:US
Mailing Address - Phone:803-646-4145
Mailing Address - Fax:
Practice Address - Street 1:1135 GREGG HWY NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6341
Practice Address - Country:US
Practice Address - Phone:803-641-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health