Provider Demographics
NPI:1659467702
Name:BAND, JENNIE P (PHD LPCS)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:P
Last Name:BAND
Suffix:
Gender:F
Credentials:PHD LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1881
Mailing Address - Country:US
Mailing Address - Phone:803-348-0638
Mailing Address - Fax:803-256-6315
Practice Address - Street 1:3103 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1881
Practice Address - Country:US
Practice Address - Phone:803-348-0638
Practice Address - Fax:803-256-6315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional