Provider Demographics
NPI:1205132461
Name:JENNINGS, CHARLES (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 COCHISE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2361
Mailing Address - Country:US
Mailing Address - Phone:248-752-5080
Mailing Address - Fax:248-254-1736
Practice Address - Street 1:6130 COCHISE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2361
Practice Address - Country:US
Practice Address - Phone:248-752-5080
Practice Address - Fax:248-254-1736
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health