Provider Demographics
NPI:1598399859
Name:HENDRIX, JENNA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 COVENTRY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2227
Mailing Address - Country:US
Mailing Address - Phone:704-650-6358
Mailing Address - Fax:
Practice Address - Street 1:6824 WILGROVE MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3428
Practice Address - Country:US
Practice Address - Phone:704-573-9777
Practice Address - Fax:704-561-6717
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-41158103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst