Provider Demographics
NPI:1114918372
Name:KNOTTS, JAY WILLIAM (MED LPC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:WILLIAM
Last Name:KNOTTS
Suffix:
Gender:M
Credentials:MED LPC
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Mailing Address - Street 1:625 GEORGIA AVE
Mailing Address - Street 2:CENTER FOR CARE AND COUNSELING FOR THE CSRA INC
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3703
Mailing Address - Country:US
Mailing Address - Phone:803-819-8021
Mailing Address - Fax:803-819-9028
Practice Address - Street 1:625 GEORGIA AVE
Practice Address - Street 2:CENTER FOR CARE AND COUNSELING FOR THE CSRA INC
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3703
Practice Address - Country:US
Practice Address - Phone:803-819-8021
Practice Address - Fax:803-819-9028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC4115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional