Provider Demographics
NPI:1164963054
Name:ROMAN, JESSICA ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 LINDEN CIR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8046
Mailing Address - Country:US
Mailing Address - Phone:843-779-2264
Mailing Address - Fax:843-628-2433
Practice Address - Street 1:14323 OCEAN HWY UNIT 4103
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4817
Practice Address - Country:US
Practice Address - Phone:843-779-2264
Practice Address - Fax:866-580-4842
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional