Provider Demographics
NPI:1518106384
Name:ANDERSON, JERLINDA JOYCE (CHES, LPC)
Entity Type:Individual
Prefix:MS
First Name:JERLINDA
Middle Name:JOYCE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CHES, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8401
Mailing Address - Country:US
Mailing Address - Phone:980-404-2365
Mailing Address - Fax:
Practice Address - Street 1:2012 HIGHWAY 160 W
Practice Address - Street 2:SUITE 16
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8401
Practice Address - Country:US
Practice Address - Phone:980-404-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 174H00000X
SC6180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator