Provider Demographics
NPI:1639528383
Name:JENKINS, JANIECE BRIANNE PETERSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANIECE
Middle Name:BRIANNE PETERSON
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 PINEVILLE MATTHEWS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5315
Mailing Address - Country:US
Mailing Address - Phone:980-308-4500
Mailing Address - Fax:980-458-6037
Practice Address - Street 1:7810 PINEVILLE MATTHEWS RD STE 7
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5315
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:980-458-6037
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0115621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical