Healthcare Provider Details

I. General information

NPI: 1174654198
Provider Name (Legal Business Name): DEE JACOBI-EDWARDS M.ED., LPTA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA MARIE BUCHANAN & DELMONTE M.ED., CRC, LPTA

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W MONTAGUE AVE STE 203
N CHARLESTON SC
29418-5907
US

IV. Provider business mailing address

313 JAMESBURY RD
CHARLESTON SC
29492-7814
US

V. Phone/Fax

Practice location:
  • Phone: 843-740-6999
  • Fax: 843-740-5433
Mailing address:
  • Phone: 972-998-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58863
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011004
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012079
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2794
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004753-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2057623
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00088976
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12955
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: