Provider Demographics
NPI:1568096071
Name:NOWACZYK, JENNA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:NOWACZYK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E PROSPECT AVE STE 215D
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3885
Mailing Address - Country:US
Mailing Address - Phone:925-315-7651
Mailing Address - Fax:
Practice Address - Street 1:145 E PROSPECT AVE STE 215D
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3885
Practice Address - Country:US
Practice Address - Phone:925-315-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health