Provider Demographics
NPI:1619039617
Name:GILMORE, JENNIFER K (EDS, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:GILMORE
Suffix:
Gender:F
Credentials:EDS, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PALMETTO PARK BLVD
Mailing Address - Street 2:LEXINGTON COUNTY MENTAL HEALTH CENTER, ADULT SRVCS
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7872
Mailing Address - Country:US
Mailing Address - Phone:803-359-3545
Mailing Address - Fax:
Practice Address - Street 1:301 PALMETTO PARK BLVD
Practice Address - Street 2:LEXINGTON COUNTY MENTAL HEALTH CENTER, ADULT SRVCS
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7872
Practice Address - Country:US
Practice Address - Phone:803-359-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4296101YP2500X
SC4259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist