Provider Demographics
NPI:1619143211
Name:JENNIFER CLEMONS, LCSW, INC
Entity Type:Organization
Organization Name:JENNIFER CLEMONS, LCSW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-400-5488
Mailing Address - Street 1:1088 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-1918
Mailing Address - Country:US
Mailing Address - Phone:828-400-5488
Mailing Address - Fax:828-456-8903
Practice Address - Street 1:1088 BROWN AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-1918
Practice Address - Country:US
Practice Address - Phone:828-400-5488
Practice Address - Fax:828-456-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005286251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143CUOtherBLUE CROSS BLUE SHIELD
NC6106342Medicaid