Provider Demographics
NPI:1326669490
Name:BEAUJON, JENNIFER R (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:BEAUJON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MS
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:BEAUJON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JEN BEAUJON MA,LPC
Mailing Address - Street 1:403 STONEY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 STONEY LANDING RD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3967
Practice Address - Country:US
Practice Address - Phone:770-873-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC435201Medicaid