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General NPI Number Information
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NPI Number | 1184752495
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Entity Type | Individual
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Provider Name | JENNIE MAY CASSIDY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 204 UNIVERSITY BLVD. COASTAL CAROLINA UNIVERSITY
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City | CONWAY
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State | SC
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Zip | 29528-6054
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Country | US
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Telephone | 843-349-2305
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Fax | 843-349-2898
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Provider Business Mailing Address
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Address Line | 280 BARCLAY DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-6572
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Country | US
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Telephone | 843-685-2125
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Fax | 843-349-2898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1042
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1042
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 1042
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License Number State | SC
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