Provider Demographics
NPI:1316582802
Name:GWALTNEY, JENNIFER (LCMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 FIRST COLONY CT
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9256
Mailing Address - Country:US
Mailing Address - Phone:252-573-8090
Mailing Address - Fax:
Practice Address - Street 1:138 FIRST COLONY CT
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9256
Practice Address - Country:US
Practice Address - Phone:252-573-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health