Healthcare Provider Details

I. General information

NPI: 1811124761
Provider Name (Legal Business Name): JOHN DANIEL LAJARA LISW-CP (LCSW)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 09/23/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BUCKWALTER PARKWAY SUITE 3UV
BLUFFTON SC
29910-4132
US

IV. Provider business mailing address

98 TURNBERRY CT
BLUFFTON SC
29909-1025
US

V. Phone/Fax

Practice location:
  • Phone: 843-290-6828
  • Fax:
Mailing address:
  • Phone: 854-290-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14397
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: