Healthcare Provider Details

I. General information

NPI: 1316826589
Provider Name (Legal Business Name): JENNIFER THOMAS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER KIRKLEY THOMAS LPN

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N CASHUA DR
FLORENCE SC
29501-6939
US

IV. Provider business mailing address

14250 N FRASER ST
GEORGETOWN SC
29440-9271
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-9320
  • Fax:
Mailing address:
  • Phone: 843-359-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP42416
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: