Provider Demographics
NPI:1356423172
Name:ROSE, JEFFREY N (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:N
Last Name:ROSE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COURTNEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2409
Mailing Address - Country:US
Mailing Address - Phone:803-414-4527
Mailing Address - Fax:
Practice Address - Street 1:140 COURTNEY OAK DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2409
Practice Address - Country:US
Practice Address - Phone:803-414-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist