Provider Demographics
NPI:1043614993
Name:LOWERY, JACKLYN (MA, LPC/I)
Entity Type:Individual
Prefix:MS
First Name:JACKLYN
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MA, LPC/I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 MCKNIGHT ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29080
Mailing Address - Country:US
Mailing Address - Phone:803-437-7204
Mailing Address - Fax:
Practice Address - Street 1:5243 MCKNIGHT ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:SC
Practice Address - Zip Code:29080
Practice Address - Country:US
Practice Address - Phone:803-437-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor