Provider Demographics
NPI:1003918889
Name:SEVICK, JENNIFER MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:SEVICK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SEVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25538
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0538
Mailing Address - Country:US
Mailing Address - Phone:864-286-1500
Mailing Address - Fax:864-234-8255
Practice Address - Street 1:355 WOODRUFF RD
Practice Address - Street 2:SUITE 405
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3429
Practice Address - Country:US
Practice Address - Phone:864-286-1500
Practice Address - Fax:864-234-8255
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare ID - Type Unspecified