Provider Demographics
NPI:1770251563
Name:MAX, JESSICA E (LPC-8864)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:E
Last Name:MAX
Suffix:
Gender:F
Credentials:LPC-8864
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UPPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-8719
Mailing Address - Country:US
Mailing Address - Phone:864-313-8240
Mailing Address - Fax:
Practice Address - Street 1:195 UPPER LAKE DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-8719
Practice Address - Country:US
Practice Address - Phone:864-313-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional