Active NPI
Jennifer Shackelford, LPC, CAC II
- Professional Counselor
- Chapin, SC
National Provider Identifier
1144652991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2195
- Practice address
- 121 Woodglen LN
Chapin, SC 29036-7513 - Phone
- (803) 407-0819
- Fax
- (803) 407-0819
- NPI assigned
- Aug 4, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1112215 | SC | |
| Professional Counselor | 101YP2500X | 2195 | SC | Primary |
Addresses
Primary practice location
121 Woodglen LN
Chapin, SC 29036-7513
Mailing address
121 Woodglen LN
Chapin, SC 29036-7513
Phone (803) 407-0819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1112215 | SC | MD | Addiction (Substance Use Disorder) Counselor |
| 2195 | SC | MD | Vision Therapy Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375574400000",
"number": "1144652991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 WOODGLEN LN",
"city": "CHAPIN",
"state": "SC",
"postal_code": "290367513",
"telephone_number": "803-407-0819",
"fax_number": "803-407-0819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 WOODGLEN LN",
"city": "CHAPIN",
"state": "SC",
"postal_code": "290367513",
"telephone_number": "803-407-0819",
"fax_number": "803-407-0819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "JENNIFER",
"credential": "LPC, CAC II",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-04",
"last_updated": "2013-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "SC",
"license": "1112215",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "2195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chapin, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.