Individual
DR. JACK L SHORTRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
5300 INTERNATIONAL BLVD, WEBSTER UNIVERSITY, N CHARLESTON, SC 29418-6937
(843) 760-1324
(843) 760-1153
Mailing address
104 W SHEPARD LN, SUMMERVILLE, SC 29483-4242
(843) 821-0323
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
KY-178
KY
106H00000X
Marriage & Family Therapist
1213
SC
Other
Enumeration date
05/14/2007
Last updated
09/11/2025
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