Provider Demographics
NPI:1376393686
Name:AMUNDSON MOSS, JENNA MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:AMUNDSON MOSS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14362
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4362
Mailing Address - Country:US
Mailing Address - Phone:919-508-7026
Mailing Address - Fax:
Practice Address - Street 1:8315 DORWOOD DR
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9028
Practice Address - Country:US
Practice Address - Phone:919-508-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0162951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical