Individual
JENNIFER L SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PC
Contact information
Practice address
110 CAMPUS DR, BRADFORD, PA 16701-1982
(814) 362-6535
Mailing address
110 CAMPUS DR, BRADFORD, PA 16701-1982
(814) 362-6535
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PC004917
PA
101YP2500X
Professional Counselor
Primary
25309452
PA
Other
Enumeration date
03/06/2018
Last updated
04/25/2018
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