Mycha I Jackson, LPC | |
4866 Greenbrier Mossydale Rd, Winnsboro, SC 29180-6523 | |
(803) 800-1701 | |
Not Available |
Full Name | Mycha I Jackson |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 4866 Greenbrier Mossydale Rd, Winnsboro, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1649700329 | NPI | - | NPPES |
3335 | Other | SC | MEDICARE PIN |
421504 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 9508 (South Carolina) | Primary |
101YM0800X | Counselor - Mental Health | 9508 (South Carolina) | Secondary |
Entity Name | Charleston Counseling Center Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1316375678 PECOS PAC ID: 6204125107 Enrollment ID: O20160517000323 |
Mailing Address | Practice Location Address |
---|---|
Mycha I Jackson, LPC 4866 Greenbrier Mossydale Rd, Winnsboro, SC 29180-6523 Ph: (803) 800-1701 | Mycha I Jackson, LPC 4866 Greenbrier Mossydale Rd, Winnsboro, SC 29180-6523 Ph: (803) 800-1701 |
Carrie Coles, Counselor Medicare: Not Enrolled in Medicare Practice Location: 200 Calhoun St, Winnsboro, SC 29180 Phone: 803-635-2335 | |
Renada Richardson, M.A., CACP-I Counselor Medicare: Not Enrolled in Medicare Practice Location: 200 Calhoun St, Winnsboro, SC 29180 Phone: 803-635-2335 Fax: 803-635-9665 | |
Cheryl A. Johnson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 511 W Moultrie St, Winnsboro, SC 29180 Phone: 803-712-1649 | |
Ms. Sharon Marion Lovelace, Counselor Medicare: Not Enrolled in Medicare Practice Location: 511 W Moultrie St, Winnsboro, SC 29180 Phone: 803-712-1649 Fax: 809-712-6960 | |
Ms. Eliza A Boulware, Counselor Medicare: Not Enrolled in Medicare Practice Location: 200 Calhoun St, Winnsboro, SC 29180 Phone: 803-635-2335 Fax: 803-635-9695 | |
Tiera Johnson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 178 Us Highway 321 Byp N, Winnsboro, SC 29180 Phone: 803-635-2335 | |
Ms. Shelia Walker, Counselor Medicare: Not Enrolled in Medicare Practice Location: 178 Us Highway 321 Byp N, Winnsboro, SC 29180 Phone: 803-635-2335 Fax: 803-635-9695 |