Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 0904011004 | VA |
Y | 1041C0700X | Clinical Social Worker | 12955 | SC |
N | 1041C0700X | Clinical Social Worker | 58863 | TX |
N | 1041C0700X | Clinical Social Worker | C012079 | NC |
N | 225200000X | Physical Therapy Assistant | 004753-1 | NY |
N | 225200000X | Physical Therapy Assistant | 2057623 | TX |
N | 225200000X | Physical Therapy Assistant | 2794 | MA |
N | 225C00000X | Rehabilitation Counselor | 00088976 | TX |
NPI | 1174654198 |
---|---|
Provider Name | Ms. Dee Jacobi-Edwards |
First Address | Charleston, SC 29492-7814 |
Second Address | N Charleston, SC 29418-5907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 01/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13955 | SOUTH CAROLINA BOARD OF SOCIAL WORK EXAMINERS (01) | SC |