Provider Demographics
NPI:1306614623
Name:HILDRETH, JESSE DIXON (LMFT-A)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:DIXON
Last Name:HILDRETH
Suffix:
Gender:M
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4422
Mailing Address - Country:US
Mailing Address - Phone:843-870-2666
Mailing Address - Fax:
Practice Address - Street 1:945 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2119
Practice Address - Country:US
Practice Address - Phone:864-383-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist