Provider Demographics
NPI:1225257298
Name:CLEMONS, JASON FRANKLIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:FRANKLIN
Last Name:CLEMONS
Suffix:
Gender:M
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:PO BOX 4325
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8325
Mailing Address - Country:US
Mailing Address - Phone:843-545-1271
Mailing Address - Fax:843-237-8551
Practice Address - Street 1:12117 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7941
Practice Address - Country:US
Practice Address - Phone:843-545-1271
Practice Address - Fax:843-237-8551
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1003Medicaid