Provider Demographics
NPI:1053451989
Name:GIESEN, JAN H (LISW-CP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:H
Last Name:GIESEN
Suffix:
Gender:F
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 1:4928 AUGUSTA HWY
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8902
Mailing Address - Country:US
Mailing Address - Phone:803-892-8848
Mailing Address - Fax:803-779-0119
Practice Address - Street 1:2712 MIDDLEBURG DR
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2415
Practice Address - Country:US
Practice Address - Phone:803-770-0354
Practice Address - Fax:803-770-0119
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0072101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical