Provider Demographics
NPI:1083951099
Name:SNOW, JANNIE D (NCACII,CACII,LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JANNIE
Middle Name:D
Last Name:SNOW
Suffix:
Gender:F
Credentials:NCACII,CACII,LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3924
Mailing Address - Country:US
Mailing Address - Phone:843-355-9113
Mailing Address - Fax:843-355-9389
Practice Address - Street 1:115 SHORT ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3924
Practice Address - Country:US
Practice Address - Phone:843-355-9113
Practice Address - Fax:843-355-9389
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11093021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3408Medicaid