Provider Demographics
NPI:1114441037
Name:JARRARD, SHELLY JENNINGS (LCSW-A)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JENNINGS
Last Name:JARRARD
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 1:356 CHARLOTTE RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2916
Mailing Address - Country:US
Mailing Address - Phone:828-287-7945
Mailing Address - Fax:
Practice Address - Street 1:94 WHITE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-4439
Practice Address - Country:US
Practice Address - Phone:828-894-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP011843101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP011843OtherLCSW-A