Provider Demographics
NPI:1245309566
Name:BRANNON, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BRANNON
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 1:104 NEW STATESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1165
Mailing Address - Country:US
Mailing Address - Phone:919-942-2803
Mailing Address - Fax:919-942-2126
Practice Address - Street 1:287 EAST ST
Practice Address - Street 2:STE 221
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8637
Practice Address - Country:US
Practice Address - Phone:919-542-4422
Practice Address - Fax:919-542-2624
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical