Individual
JASON FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 CALENDAR CT, COLUMBIA, SC 29206-4715
(803) 470-4438
Mailing address
1104 BELLEVIEW ST, COLUMBIA, SC 29201-1800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8047
SC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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