Provider Demographics
NPI:1710677067
Name:REXRODE, JESSICA KAY (LPC/A)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:REXRODE
Suffix:
Gender:F
Credentials:LPC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 SAINT ANDREWS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3143
Mailing Address - Country:US
Mailing Address - Phone:803-834-9238
Mailing Address - Fax:
Practice Address - Street 1:6334 SAINT ANDREWS RD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3143
Practice Address - Country:US
Practice Address - Phone:803-834-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health