Provider Demographics
NPI:1649335704
Name:MAZGAJ, JAMIE (EDD, LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MAZGAJ
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801-D WEST EVANS STREET
Mailing Address - Street 2:STE 105
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3676
Mailing Address - Country:US
Mailing Address - Phone:843-496-6454
Mailing Address - Fax:843-661-1010
Practice Address - Street 1:1801-D WEST EVANS STREET
Practice Address - Street 2:STE 105
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3676
Practice Address - Country:US
Practice Address - Phone:843-496-6454
Practice Address - Fax:843-661-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4782101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4782OtherLPC
SCPC1000Medicaid