Provider Demographics
NPI:1144652520
Name:JENNINGS, ANTIONETTE B (LCSW-A)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:B
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FAISON W MCGOWAN RD
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-8930
Mailing Address - Country:US
Mailing Address - Phone:910-275-0369
Mailing Address - Fax:
Practice Address - Street 1:3331 EASY ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7988
Practice Address - Country:US
Practice Address - Phone:910-567-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0083181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical