Provider Demographics
NPI:1912956111
Name:MCDONALD, JACQUELYN A (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3537
Mailing Address - Country:US
Mailing Address - Phone:843-853-4338
Mailing Address - Fax:843-763-1418
Practice Address - Street 1:7 GAMECOCK AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3379
Practice Address - Country:US
Practice Address - Phone:843-763-1455
Practice Address - Fax:843-763-1418
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional