1003875519 NPI number — JENNIFER F ELKINS EDD LPC LPCS RPTS

Table of content: MISS GABRIELA GARCIA (NPI 1740544618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003875519 NPI number — JENNIFER F ELKINS EDD LPC LPCS RPTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELKINS
Provider First Name:
JENNIFER
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDD LPC LPCS RPTS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERGUSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003875519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
887 NE MAIN ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-615-2770
Provider Business Mailing Address Fax Number:
864-228-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
887 NE MAIN ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29681-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-538-6906
Provider Business Practice Location Address Fax Number:
864-479-4141
Provider Enumeration Date:
03/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4156 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP5471 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PC1016 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".