Provider Demographics
NPI:1184807364
Name:DRIGGERS, JESSIE
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166B CLAUDE BUNDRICK RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9419
Mailing Address - Country:US
Mailing Address - Phone:803-786-7667
Mailing Address - Fax:
Practice Address - Street 1:200 CLAUDE BUNDRICK RD
Practice Address - Street 2:KIVA LODGE
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9420
Practice Address - Country:US
Practice Address - Phone:803-754-5478
Practice Address - Fax:803-754-9644
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health