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Individual

JACQUELYNE JONES WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LPC

Contact information

Practice address
4705 OLEANDER DR, MYRTLE BEACH, MYRTLE BEACH, SC 29577-5751
(843) 222-1188
Mailing address
PO BOX 70651, MYRTLE BEACH, SC 29572-0029
(843) 222-1188

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
07/15/2006
Last updated
10/03/2013
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