Provider Demographics
NPI:1306413414
Name:PENNIC, CHRISTAL (LPC MHSP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:
Last Name:PENNIC
Suffix:
Gender:F
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 BRADBURN VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2295
Mailing Address - Country:US
Mailing Address - Phone:615-533-3548
Mailing Address - Fax:
Practice Address - Street 1:639 BRADBURN VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2295
Practice Address - Country:US
Practice Address - Phone:615-533-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional