| Susan Lea, Llc | |
|
101 W St John St Suite 103 Spartanburg SC 29306 | |
| (864) 406-5774 | |
| (864) 778-2983 |
| Full Name | Susan Lea, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 101 W St John St, Spartanburg, South Carolina |
| Authorized Official Name and Position | Susan Lea (OWNER AND PRINCIPAL) |
| Authorized Official Contact | 8644065774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan Lea, Llc 101 W St John St Suite 103 Spartanburg SC 29306 Ph: (864) 406-5774 | Susan Lea, Llc 101 W St John St Suite 103 Spartanburg SC 29306 Ph: (864) 406-5774 |
| NPI Number | 1174103543 |
|---|---|
| Provider Enumeration Date | 04/10/2021 |
| Last Update Date | 02/06/2025 |
| Certification Date | 08/26/2024 |
| Medicare PECOS PAC ID | 4789100504 |
|---|---|
| Medicare Enrollment ID | O20250424002466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174103543 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Susan R Lea |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750809554 PECOS PAC ID: 1850744145 Enrollment ID: I20240202002105 |
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