Individual provider · NPI-1

Jacqueline Marie Addis

Counselor, Mental Health · Greenville, SC

NPI number1063118701
StatusActive
Last updated in NPPESFeb 3, 2023

Details

NPI
1063118701
Entity type
Individual (NPI-1)
Name
Jacqueline Marie Addis
Sex
Female
Sole proprietor
No
Enumeration date
Feb 3, 2023
Certification date
Feb 3, 2023
Last updated
Feb 3, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental Health––Yes

Practice location

124 Mallard St
Greenville, SC 29601-4046

Phone 864-241-1040

Mailing address

124 Mallard St
Greenville, SC 29601-4046

Phone 864-241-1040

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