Provider Demographics
NPI:1902219587
Name:KENNINGTON, JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KENNINGTON
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 1:4613 PARKWAY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1191
Mailing Address - Country:US
Mailing Address - Phone:870-330-4095
Mailing Address - Fax:844-706-5741
Practice Address - Street 1:4613 PARKWAY DR STE 7
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1191
Practice Address - Country:US
Practice Address - Phone:870-330-4095
Practice Address - Fax:844-706-5741
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202688795Medicaid