Provider Demographics
NPI:1821603168
Name:MORRISON, JAIMZ
Entity type:Individual
Prefix:
First Name:JAIMZ
Middle Name:
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 CATFISH CV
Mailing Address - Street 2:
Mailing Address - City:CHAPPELLS
Mailing Address - State:SC
Mailing Address - Zip Code:29037-8950
Mailing Address - Country:US
Mailing Address - Phone:864-323-7427
Mailing Address - Fax:
Practice Address - Street 1:488 CATFISH CV
Practice Address - Street 2:
Practice Address - City:CHAPPELLS
Practice Address - State:SC
Practice Address - Zip Code:29037-8950
Practice Address - Country:US
Practice Address - Phone:864-323-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBA1280Medicaid