Individual
MYCHA I JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4866 GREENBRIER MOSSYDALE RD, WINNSBORO, SC 29180-6523
(803) 800-1701
Mailing address
4866 GREENBRIER MOSSYDALE RD, WINNSBORO, SC 29180-6523
(803) 800-1701
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
9508
SC
101YP2500X
Professional Counselor
Primary
9508
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3335
MEDICARE PIN
SC
05
—
421504
—
SC
Enumeration date
06/15/2017
Last updated
10/10/2024
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