Provider Demographics
NPI:1952019150
Name:BUS, JENA (LISW-CP)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:BUS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RIVERWALK BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-3252
Mailing Address - Country:US
Mailing Address - Phone:843-636-5017
Mailing Address - Fax:843-206-0256
Practice Address - Street 1:61 RIVERWALK BLVD STE H
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3252
Practice Address - Country:US
Practice Address - Phone:843-636-5017
Practice Address - Fax:843-206-0256
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC130031041C0700X
SC156661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical