Healthcare Provider Details

I. General information

NPI: 1508521873
Provider Name (Legal Business Name): JENNIFER NILSSEN LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGTREE DR STE 200
COLUMBIA SC
29223-8614
US

IV. Provider business mailing address

200 SPRINGTREE DR STE 200
COLUMBIA SC
29223-8614
US

V. Phone/Fax

Practice location:
  • Phone: 803-722-4975
  • Fax: 803-722-6018
Mailing address:
  • Phone: 803-722-4975
  • Fax: 803-722-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7839
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: