Healthcare Provider Details

I. General information

NPI: 1063383156
Provider Name (Legal Business Name): J'HARIA DALLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 GARNER LN STE 103A
COLUMBIA SC
29210-8300
US

IV. Provider business mailing address

1345 GARNER LN STE 103A
COLUMBIA SC
29210-8300
US

V. Phone/Fax

Practice location:
  • Phone: 706-332-9727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11434
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: