Individual
MISS TRINICIA RENEE LAVON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1105 BELLEVIEW ST STE 103, COLUMBIA, SC 29201-1839
(803) 250-5570
Mailing address
6530 DAVIDSON ST APT C1, COLUMBIA, SC 29209-1732
(803) 447-3949
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
7112
SC
101YM0800X
Mental Health Counselor
Primary
7802
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC2451
—
SC
Enumeration date
07/02/2020
Last updated
09/09/2021
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