Provider Demographics
NPI:1003590340
Name:ALLRED, JERRY LEE JR (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:LEE
Last Name:ALLRED
Suffix:JR
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CROSSWELL DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3611
Mailing Address - Country:US
Mailing Address - Phone:803-651-1300
Mailing Address - Fax:803-774-6442
Practice Address - Street 1:11 CROSSWELL DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3611
Practice Address - Country:US
Practice Address - Phone:803-803-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical