Healthcare Provider Details

I. General information

NPI: 1740801984
Provider Name (Legal Business Name): JEANNIE JAMES LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N KINGS HWY
MYRTLE BEACH SC
29577-3722
US

IV. Provider business mailing address

PO BOX 2967
MYRTLE BEACH SC
29578-2967
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-4820
  • Fax: 843-448-9875
Mailing address:
  • Phone: 843-448-4820
  • Fax: 843-448-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2541
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: