Individual
JALISSA ANN JERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 HARRINGTON ST, BEAUFORT, SC 29902
(843) 524-8899
Mailing address
1050 RIBAUT RD, BEAUFORT, SC 29902-5400
(843) 524-8899
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
576000922
—
SC
Enumeration date
08/03/2017
Last updated
07/21/2022
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