Provider Demographics
NPI:1942547138
Name:MOORE, JENNIFER LOADHOLT (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOADHOLT
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2623
Mailing Address - Country:US
Mailing Address - Phone:843-645-7700
Mailing Address - Fax:
Practice Address - Street 1:204 NORTH RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10158OtherDEPARTMENT OF LABOR, LICENSING AND REGULATION BOARD OF SOCIAL WORK EXAMINERS