Healthcare Provider Details

I. General information

NPI: 1124947007
Provider Name (Legal Business Name): JACKSON BIRCHFIELD M.A., LPC-A, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARRIAGE LN
CHARLESTON SC
29407-6060
US

IV. Provider business mailing address

1845 OTIS AVE
CHARLESTON SC
29414-6200
US

V. Phone/Fax

Practice location:
  • Phone: 854-205-2919
  • Fax:
Mailing address:
  • Phone: 854-205-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11069
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: