Provider Demographics
NPI:1184969446
Name:DALEY, JENNA KATELYN (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:KATELYN
Last Name:DALEY
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:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-0381
Mailing Address - Country:US
Mailing Address - Phone:704-892-8489
Mailing Address - Fax:
Practice Address - Street 1:19900 S MAIN ST STE 8&9
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6512
Practice Address - Country:US
Practice Address - Phone:704-892-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0076221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical