MEDICARE: JESSIE BRZEZINSKI MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4705	SC

General Provider Information

NPI Number	:	1346571007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE BRZEZINSKI MA, LPC

Provider Business Mailing Address
First Line	:	222 W COLEMAN BLVD
Second Line	:	SUITE 213
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W COLEMAN BLVD
Second Line	:	SUITE 213
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3588
Country	:	US
Telephone Number	:	843-693-2002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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