Provider Demographics
NPI:1598053449
Name:FENNELL, ZENOBIA BERNADETTE (DMIN LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:ZENOBIA
Middle Name:BERNADETTE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:DMIN LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4206
Mailing Address - Country:US
Mailing Address - Phone:336-703-3652
Mailing Address - Fax:
Practice Address - Street 1:741 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4206
Practice Address - Country:US
Practice Address - Phone:336-703-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2825-A101YA0400X
NCC0083701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)