Provider Demographics
NPI:1922566546
Name:ATHERTON, JEANINNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANINNE
Middle Name:
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANINNE
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 W LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1857
Mailing Address - Country:US
Mailing Address - Phone:850-469-3907
Mailing Address - Fax:
Practice Address - Street 1:1221 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1857
Practice Address - Country:US
Practice Address - Phone:850-469-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW157321041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical