Provider Demographics
NPI:1063039881
Name:GAYKEN, JEFFERY LEWIS (LPC, CAC-I)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LEWIS
Last Name:GAYKEN
Suffix:
Gender:M
Credentials:LPC, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-8360
Mailing Address - Country:US
Mailing Address - Phone:803-308-0922
Mailing Address - Fax:
Practice Address - Street 1:719 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3432
Practice Address - Country:US
Practice Address - Phone:803-308-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1910242101YA0400X
SC6540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)