Active NPI
M Jennifer Wattenbarger, M.ED., LPC
- Professional Counselor
- Conway, SC
National Provider Identifier
1730112913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2489
- Practice address
- 164 Waccamaw Medical Park Dr
Conway, SC 29526-8903 - Phone
- (843) 347-5060
- NPI assigned
- Jul 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2489 | SC | Primary |
Addresses
Primary practice location
164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Mailing address
1623 25TH Ave N
North Myrtle Beach, SC 29582-6103
Phone (843) 249-2069
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2489 | SC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730112913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1623 25TH AVE N",
"city": "NORTH MYRTLE BEACH",
"state": "SC",
"postal_code": "295826103",
"telephone_number": "843-249-2069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 WACCAMAW MEDICAL PARK DR",
"city": "CONWAY",
"state": "SC",
"postal_code": "295268903",
"telephone_number": "843-347-5060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTENBARGER",
"first_name": "M",
"middle_name": "JENNIFER",
"credential": "M.ED., LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "2489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.