Healthcare Provider Details

I. General information

NPI: 1780008912
Provider Name (Legal Business Name): JENNIFER VILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LASH

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PALMETTO PARK BLVD
LEXINGTON SC
29072-7872
US

IV. Provider business mailing address

160 BROAD OAK LN
LEXINGTON SC
29072-8270
US

V. Phone/Fax

Practice location:
  • Phone: 803-996-1500
  • Fax:
Mailing address:
  • Phone: 225-287-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8865
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberAN 534923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: