Provider Demographics
NPI:1104456375
Name:BRENTS, JODI LYNN (PSYD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:BRENTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ARENDELL ST STE 19B
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3393
Mailing Address - Country:US
Mailing Address - Phone:252-240-2349
Mailing Address - Fax:
Practice Address - Street 1:2900 ARENDELL ST STE 19B
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3393
Practice Address - Country:US
Practice Address - Phone:252-240-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPROVISIONAL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist