Provider Demographics
NPI:1710512082
Name:RECORD, JEANNE RAE (LPC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:RAE
Last Name:RECORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PENNINGTON DR STE C
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9014
Mailing Address - Country:US
Mailing Address - Phone:843-384-4994
Mailing Address - Fax:
Practice Address - Street 1:49 PENNINGTON DR STE C
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9014
Practice Address - Country:US
Practice Address - Phone:843-384-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherNONE