Provider Demographics
NPI:1790322493
Name:HAZEL-WORLEY, JENNIFER (LLMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAZEL-WORLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 WOODLAND CREEK DR SE APT 102
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-8313
Mailing Address - Country:US
Mailing Address - Phone:810-543-0501
Mailing Address - Fax:
Practice Address - Street 1:4700 CANAL AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-9724
Practice Address - Country:US
Practice Address - Phone:616-439-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty