Provider Demographics
NPI:1457692659
Name:JOSEPH, JERILYN T (MHP)
Entity type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:T
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ASHLEY HALL ROAD
Mailing Address - Street 2:APT S4
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3834
Mailing Address - Country:US
Mailing Address - Phone:843-973-2528
Mailing Address - Fax:
Practice Address - Street 1:1721 ASHLEY HALL RD
Practice Address - Street 2:APT S4
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3834
Practice Address - Country:US
Practice Address - Phone:843-973-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1457692659Medicaid