Healthcare Provider Details

I. General information

NPI: 1972285724
Provider Name (Legal Business Name): JENNIE LEE GAMBLE M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SWEETBRIAR RD STE A6
GREENVILLE SC
29615-1462
US

IV. Provider business mailing address

25 SWEETBRIAR RD STE A6
GREENVILLE SC
29615-1462
US

V. Phone/Fax

Practice location:
  • Phone: 864-790-4963
  • Fax: 877-744-5147
Mailing address:
  • Phone: 864-790-4963
  • Fax: 877-744-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11249
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: