Provider Demographics
NPI:1194490896
Name:ROBERSON, JESSICA RAINEY (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAINEY
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ERIN
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1000 CLYBURN PL
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4193
Mailing Address - Country:US
Mailing Address - Phone:803-380-7000
Mailing Address - Fax:
Practice Address - Street 1:4645 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:BEECH ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29842-7265
Practice Address - Country:US
Practice Address - Phone:803-380-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12905104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty