Provider Demographics
NPI:1073133559
Name:FORD, JIMIKO W (LCSW, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:JIMIKO
Middle Name:W
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-8558
Mailing Address - Country:US
Mailing Address - Phone:803-670-2555
Mailing Address - Fax:
Practice Address - Street 1:1166 CAMP CREEK RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-8558
Practice Address - Country:US
Practice Address - Phone:803-670-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC013620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty