Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACK L SHORTRIDGE, ED.D.
Active Sole ProprietorDR. JACK L SHORTRIDGE, ED.D. is a Counseling Psychologist healthcare provider located in N CHARLESTON, South Carolina. NPI 1811103468 is currently active in the NPPES registry. Verify at CMS.
Counseling Psychologist · N CHARLESTON, SC
Registration Details
- NPI Number
- 1811103468
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 14, 2007 (19.22199727864 yrs)
- Last Updated
- Sep 11, 2025
- Licenses
-
KY-178 (KY)1213 (SC)
- Sole Proprietor
- Yes
Practice Information
- Address
-
5300 INTERNATIONAL BLVDWEBSTER UNIVERSITYN CHARLESTON, SC, 294186937Browse SC providers · Browse ZIP 29418
- Phone
- 8437601324
- Fax
- 8437601153
- Primary Specialty
-
Counseling Psychologist
103TC1900X
- Additional Specialty
- Marriage & Family Therapist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.