Provider Demographics
NPI:1982402772
Name:LINCOLN, JENNIFER M (LPES)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LINCOLN
Suffix:
Gender:
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SPRINGHALL DR STE A
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5360
Mailing Address - Country:US
Mailing Address - Phone:843-376-3112
Mailing Address - Fax:
Practice Address - Street 1:118 SPRINGHALL DR STE A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5360
Practice Address - Country:US
Practice Address - Phone:843-376-3112
Practice Address - Fax:843-594-0110
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4825103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool