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Individual

JACLYN SOUSA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
308 BERMUDA TOWNE ROW, MT PLEASANT, SC 29464-8230
(203) 518-1667
Mailing address
308 BERMUDA TOWNE ROW, MT PLEASANT, SC 29464-8230

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
021648-1
NY
103TC0700X
Clinical Psychologist
10929
MA
103TC0700X
Clinical Psychologist
Primary
1657
SC

Other

Enumeration date
07/01/2016
Last updated
10/22/2021
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