Provider Demographics
NPI:1174654198
Name:JACOBI-EDWARDS, DEE (MED, LPTA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEE
Middle Name:
Last Name:JACOBI-EDWARDS
Suffix:
Gender:F
Credentials:MED, LPTA, LCSW
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:BUCHANAN & DELMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CRC, LPTA
Mailing Address - Street 1:313 JAMESBURY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7814
Mailing Address - Country:US
Mailing Address - Phone:972-998-1980
Mailing Address - Fax:
Practice Address - Street 1:3300 W MONTAGUE AVE STE 203
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5907
Practice Address - Country:US
Practice Address - Phone:843-740-6999
Practice Address - Fax:843-740-5433
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588631041C0700X
VA09040110041041C0700X
NCC0120791041C0700X
MA2794225200000X
NY004753-1225200000X
TX2057623225200000X
TX00088976225C00000X
SC129551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC13955OtherSOUTH CAROLINA BOARD OF SOCIAL WORK EXAMINERS