Individual
JEREMY CRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301A PALMETTO PARK BLVD, LEXINGTON, SC 29072-7872
(803) 359-3545
Mailing address
34 WOODCROSS DR, 210, COLUMBIA, SC 29212-2355
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5624
SC
Other
Enumeration date
08/28/2014
Last updated
08/28/2014
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