Provider Demographics
NPI:1770253544
Name:PALMER, JOHN ROSS SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROSS
Last Name:PALMER
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 JAMISON RD
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6903
Mailing Address - Country:US
Mailing Address - Phone:843-291-6318
Mailing Address - Fax:
Practice Address - Street 1:THE MARY JENKINS CENTER FOR BEHAVIORAL HEALTH
Practice Address - Street 2:3300 W MONTAGUE AVENUE SUITE 203
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-740-6999
Practice Address - Fax:843-740-5433
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty