Provider Demographics
NPI:1750332359
Name:PENINGTON, JANICE HARVEY (LPC SC NC CACII SC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:HARVEY
Last Name:PENINGTON
Suffix:
Gender:F
Credentials:LPC SC NC CACII SC
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:HARVEY
Other - Last Name:PENINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 JORDAN STREET
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712
Mailing Address - Country:US
Mailing Address - Phone:828-553-3640
Mailing Address - Fax:828-883-9227
Practice Address - Street 1:44 JORDAN STREET
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-553-3640
Practice Address - Fax:828-883-9227
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC53214101YA0400X
SC0610277101YA0400X
NC4941101YP2500X, 101YM0800X
SC2700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102988Medicaid