Provider Demographics
NPI:1316389547
Name:LABOE, JASON T
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:LABOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4264
Mailing Address - Country:US
Mailing Address - Phone:803-328-9600
Mailing Address - Fax:803-329-7141
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4541
Practice Address - Country:US
Practice Address - Phone:803-328-9600
Practice Address - Fax:803-329-7141
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health