Provider Demographics
NPI:1114984721
Name:ELLIOTT, JEAN MARIE (MED, LPC, NCC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MED, LPC, NCC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SAVANNAH HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7349
Mailing Address - Country:US
Mailing Address - Phone:843-556-4541
Mailing Address - Fax:843-556-1599
Practice Address - Street 1:815 SAVANNAH HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7349
Practice Address - Country:US
Practice Address - Phone:843-556-4541
Practice Address - Fax:843-556-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional