Provider Demographics
NPI:1407228653
Name:CANTY, JEWEL LEANNE (LPC)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:LEANNE
Last Name:CANTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PINE MAST CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0919
Mailing Address - Country:US
Mailing Address - Phone:803-979-7096
Mailing Address - Fax:
Practice Address - Street 1:100 ASHLAND PARK LN
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5100
Practice Address - Country:US
Practice Address - Phone:803-708-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6221101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor