Provider Demographics
NPI:1043093578
Name:BLESSING, JACOB (LPC-A)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BLESSING
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SEVEN FARMS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8040
Mailing Address - Country:US
Mailing Address - Phone:843-214-9389
Mailing Address - Fax:
Practice Address - Street 1:295 SEVEN FARMS DR STE 203
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8040
Practice Address - Country:US
Practice Address - Phone:843-214-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty