Provider Demographics
NPI:1538361746
Name:JENNIFER A. BENNICE, PHD
Entity type:Organization
Organization Name:JENNIFER A. BENNICE, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-330-8663
Mailing Address - Street 1:152 CANNON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5717
Mailing Address - Country:US
Mailing Address - Phone:843-330-8663
Mailing Address - Fax:480-393-5485
Practice Address - Street 1:152 CANNON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5717
Practice Address - Country:US
Practice Address - Phone:843-330-8663
Practice Address - Fax:480-393-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC985251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health