Provider Demographics
NPI:1639735004
Name:HENDERSON-TEELUCKSINGH, JEREMY (MA, MHR)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HENDERSON-TEELUCKSINGH
Suffix:
Gender:M
Credentials:MA, MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 HOLMGREN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8372
Mailing Address - Country:US
Mailing Address - Phone:415-786-9129
Mailing Address - Fax:
Practice Address - Street 1:9217 UNIVERSITY BLVD STE C1A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9147
Practice Address - Country:US
Practice Address - Phone:843-619-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health