Provider Demographics
NPI:1306977665
Name:SINGLETON, JEANNETTE (MED)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:S
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 WEDDELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5644
Mailing Address - Country:US
Mailing Address - Phone:803-234-3205
Mailing Address - Fax:
Practice Address - Street 1:220 FAISON DRIVE
Practice Address - Street 2:BRYAN KIVA PROJECT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-935-5395
Practice Address - Fax:803-935-5135
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator