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General NPI Number Information
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NPI Number | 1700964756
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Entity Type | Individual
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Provider Name | CANDACE J JENKINS LPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 121 EXECUTIVE CENTER DR STE 102
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City | COLUMBIA
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State | SC
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Zip | 29210-8418
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Country | US
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Telephone | 843-894-0000
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Fax | 843-589-9054
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Provider Business Mailing Address
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Address Line | PO BOX 16091
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City | SURFSIDE BEACH
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State | SC
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Zip | 29587-6091
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Country | US
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Telephone | 843-894-0000
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Fax | 843-589-9054
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9986
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License Number State | SC
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