Provider Demographics
NPI:1083397293
Name:REILLEY, JADA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:MARIE
Last Name:REILLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RIVERWALK BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-3252
Mailing Address - Country:US
Mailing Address - Phone:843-636-5017
Mailing Address - Fax:843-202-0256
Practice Address - Street 1:61 RIVERWALK BLVD STE H
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3252
Practice Address - Country:US
Practice Address - Phone:843-636-5017
Practice Address - Fax:843-202-0256
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC153591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical