Provider Demographics
NPI:1700583358
Name:CANFORA, JENNIFER HALL (PHD, LPCA)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HALL
Last Name:CANFORA
Suffix:
Gender:F
Credentials:PHD, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 44TH AVE N STE 103
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5978
Mailing Address - Country:US
Mailing Address - Phone:843-604-5530
Mailing Address - Fax:
Practice Address - Street 1:3455 BROAD ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-3001
Practice Address - Country:US
Practice Address - Phone:854-901-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health