Provider Demographics
NPI:1184902108
Name:WELLER-WHITE, JENNIFFER (LISW-CP, CACII)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:
Last Name:WELLER-WHITE
Suffix:
Gender:F
Credentials:LISW-CP, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 AUTUMN STROLL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9318
Mailing Address - Country:US
Mailing Address - Phone:803-553-3837
Mailing Address - Fax:
Practice Address - Street 1:2437 MINERAL SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9145
Practice Address - Country:US
Practice Address - Phone:803-553-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9838101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)