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General NPI Number Information
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NPI Number | 1003266784
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Entity Type | Organization
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Legal Business Name | JERIDO-FAIR COUNSELING SERVICES
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 608 KING ST
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City | WALTERBORO
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State | SC
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Zip | 29488-5330
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Country | US
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Telephone | 843-635-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 608 KING ST
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City | WALTERBORO
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State | SC
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Zip | 29488-5330
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Country | US
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Telephone | 843-635-0149
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALISTS
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Name | KIMBERLY DAVIS
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Credential |
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Telephone | 912-484-3879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6284
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License Number State | SC
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