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General NPI Number Information
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NPI Number | 1316826589
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Entity Type | Individual
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Provider Name | JENNIFER THOMAS LPN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 1341 N CASHUA DR
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City | FLORENCE
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State | SC
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Zip | 29501-6939
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Country | US
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Telephone | 843-673-9320
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Fax |
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Provider Business Mailing Address
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Address Line | 14250 N FRASER ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-9271
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Country | US
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Telephone | 843-359-7509
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | P42416
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License Number State | SC
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