Individual provider Active NPI

Jamie Lee Barkdull

  • Mental Health Counselor
  • Conway, SC
National Provider Identifier
1831862911
Registry record updated Jul 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
9815 Issued in SC
Practice address
164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone
(843) 347-4888
NPI assigned
Jul 26, 2021
Last updated
Jul 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Mental Health Counselor 101YM0800X 9815 SC Primary

Addresses

Primary practice location

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903

Mailing address

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone (843) 347-4888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241023002840 SC Practitioner - Mental Health Counselor 1254864630 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone (843) 347-5060

6306 B Timberline St
Myrtle Beach, SC 29572-3204
Phone (843) 902-6652

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9815SCMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Oct 8, 2024 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Oct 8, 2024 Accepting new patients
Tranquil Tides Counseling & Wellness, LLC CurrentSince Jan 19, 2026 Accepting new patients

Locations

164 Waccamaw Medical Park Dr
Conway, SC 29526
Phone (843) 347-4888

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751760000000",
    "number": "1831862911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268903",
            "telephone_number": "843-347-4888"
        },
        {
            "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": "843-347-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARKDULL",
        "first_name": "JAMIE",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2025-07-06",
        "certification_date": "2025-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "9815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.