Provider Demographics
NPI:1730213166
Name:PEEBLES, SUZANNE WILSON (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:WILSON
Last Name:PEEBLES
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:PO BOX 25453
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-5453
Mailing Address - Country:US
Mailing Address - Phone:803-782-5556
Mailing Address - Fax:803-788-0914
Practice Address - Street 1:6941 N TRENHOLM RD
Practice Address - Street 2:SUITE R-2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-1715
Practice Address - Country:US
Practice Address - Phone:803-782-5556
Practice Address - Fax:803-788-0914
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health