Doctor Name: | JENNIFER SHACKELFORD |
NPI Number: | 1144652991 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, CAC II |
License Number: | 1112215 |
Business Practice Address: | 121 Woodglen Ln Chapin, SC - 290367513 |
Business Phone Number: | 8034070819 |
Business Fax Number: | 8034070819 |
Mailing Address: | 121 Woodglen Ln, CHAPIN |
State: | SC |
Postal Code: | 290367513 |
Phone Number: | 8034070819 |
Fax Number: | 8034070819 |
NPI Enumeration Date: | 08/04/2013 |
NPI Last Update Date: | 08/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1112215 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |