Individual
JACK H BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D, LPC
Contact information
Practice address
709 OLD TROLLEY RD, SUMMERVILLE, SC 29485-5203
(843) 821-2480
(843) 875-3149
Mailing address
709 OLD TROLLEY RD, SUMMERVILLE, SC 29485-5203
(843) 821-2480
(843) 875-3149
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2674
SC
Other
Enumeration date
07/05/2006
Last updated
07/08/2007
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