Provider Demographics
NPI:1417667668
Name:JENNINGS, ELIZABETH (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9172
Mailing Address - Country:US
Mailing Address - Phone:252-489-6356
Mailing Address - Fax:
Practice Address - Street 1:1015 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5969
Practice Address - Country:US
Practice Address - Phone:252-695-0269
Practice Address - Fax:252-413-0526
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18231101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor