Healthcare Provider Details

I. General information

NPI: 1508110594
Provider Name (Legal Business Name): BLANCHIE J. JAMES LPC, LPC/S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 W JODY RD SUITE E
FLORENCE SC
29501-2008
US

IV. Provider business mailing address

2120 JODY ROAD SUITE E
FLORENCE SC
29501
US

V. Phone/Fax

Practice location:
  • Phone: 843-317-4021
  • Fax: 843-317-4018
Mailing address:
  • Phone: 843-317-4021
  • Fax: 843-317-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4746
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: