Provider Demographics
NPI:1144909607
Name:CUSHMAN, JENNIFER PARISOT (LPCA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PARISOT
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WINDJAMMER LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-7235
Mailing Address - Country:US
Mailing Address - Phone:864-270-1675
Mailing Address - Fax:
Practice Address - Street 1:702 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3121
Practice Address - Country:US
Practice Address - Phone:864-416-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional