Provider Demographics
NPI:1427404821
Name:POACHES, JENNIFER DEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DEE
Last Name:POACHES
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 1:1350 WALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6440
Mailing Address - Country:US
Mailing Address - Phone:281-748-4859
Mailing Address - Fax:
Practice Address - Street 1:1350 WALLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6440
Practice Address - Country:US
Practice Address - Phone:281-748-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional