Provider Demographics
NPI:1225524721
Name:LAWLER, JESSICA MOGER (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MOGER
Last Name:LAWLER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOVE FIELD CT
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9240
Mailing Address - Country:US
Mailing Address - Phone:507-676-5636
Mailing Address - Fax:
Practice Address - Street 1:3800 FOREST DR STE A204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4146
Practice Address - Country:US
Practice Address - Phone:803-216-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3098106H00000X
SC4685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist