Provider Demographics
NPI:1326561929
Name:PETTEE, JENNIFER TREMBLAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TREMBLAY
Last Name:PETTEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4144
Mailing Address - Country:US
Mailing Address - Phone:336-280-5432
Mailing Address - Fax:252-222-3100
Practice Address - Street 1:1104 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4144
Practice Address - Country:US
Practice Address - Phone:336-280-5432
Practice Address - Fax:252-222-3100
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0108971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical