Provider Demographics
NPI:1639850654
Name:JESSUP-CLOWNEY, RICKIA
Entity Type:Individual
Prefix:
First Name:RICKIA
Middle Name:
Last Name:JESSUP-CLOWNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7343
Mailing Address - Country:US
Mailing Address - Phone:864-901-8845
Mailing Address - Fax:864-406-6042
Practice Address - Street 1:101 N PINE ST STE 210
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1604
Practice Address - Country:US
Practice Address - Phone:864-529-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional