Provider Demographics
NPI:1538840665
Name:SHIRLEY, JENNIFER CAROLINE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROLINE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 CAPE OWEN MANOR RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-5114
Mailing Address - Country:US
Mailing Address - Phone:252-714-7278
Mailing Address - Fax:
Practice Address - Street 1:817B S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4613
Practice Address - Country:US
Practice Address - Phone:910-207-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0194131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical