Provider Demographics
NPI:1295230936
Name:MCGONIGAL, JENNIFER JOANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOANN
Last Name:MCGONIGAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RONNIE CT STE 2
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4192
Mailing Address - Country:US
Mailing Address - Phone:843-333-1040
Mailing Address - Fax:843-432-3091
Practice Address - Street 1:220 RONNIE CT STE 2
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4192
Practice Address - Country:US
Practice Address - Phone:843-333-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health