Provider Demographics
NPI:1225245483
Name:WARDELL, JENEVIEVE LYNN (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:JENEVIEVE
Middle Name:LYNN
Last Name:WARDELL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 DOE CREEK TRL N
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-5018
Mailing Address - Country:US
Mailing Address - Phone:704-231-4215
Mailing Address - Fax:
Practice Address - Street 1:2375 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1756
Practice Address - Country:US
Practice Address - Phone:662-506-3836
Practice Address - Fax:662-200-5976
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12683101YM0800X
MS2757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health