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Individual

MRS. SHANTA AVALICE JERIDEAU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
200 SPRINGTREE DR STE 200, COLUMBIA, SC 29223-8614
(803) 722-4975
(803) 722-6018
Mailing address
200 SPRINGTREE DR STE 200, COLUMBIA, SC 29223-8614
(803) 722-4975
(803) 722-6018

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
10/19/2012
Last updated
11/03/2020
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