Individual
MISS JACKIE DENISE BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2375 E MAIN ST, SPARTANBURG, SC 29307-1434
(864) 978-7086
Mailing address
PO BOX 96, MOORE, SC 29369-0096
(864) 978-7086
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2765
SC
Other
Enumeration date
09/04/2007
Last updated
09/04/2007
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