Healthcare Provider Details

I. General information

NPI: 1700964756
Provider Name (Legal Business Name): CANDACE J JENKINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 EXECUTIVE CENTER DR STE 102
COLUMBIA SC
29210-8418
US

IV. Provider business mailing address

PO BOX 16091
SURFSIDE BEACH SC
29587-6091
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-0000
  • Fax: 843-589-9054
Mailing address:
  • Phone: 843-894-0000
  • Fax: 843-589-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9986
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: