Provider Demographics
NPI:1699046904
Name:POINDEXTER, JENNIFER MARIE (LPC-I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4339
Mailing Address - Country:US
Mailing Address - Phone:846-349-2305
Mailing Address - Fax:
Practice Address - Street 1:607 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4339
Practice Address - Country:US
Practice Address - Phone:843-685-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001157101YP2500X
SC5797101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional