Provider Demographics
NPI:1841343589
Name:JAFARIAN, MONA PATRICIA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:PATRICIA
Last Name:JAFARIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 HIGH BRASS TRL
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8413
Mailing Address - Country:US
Mailing Address - Phone:410-920-7464
Mailing Address - Fax:
Practice Address - Street 1:608 16TH AVE N STE G
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3537
Practice Address - Country:US
Practice Address - Phone:843-823-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079911041C0700X
SC149441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical