Provider Demographics
NPI:1245354760
Name:BYRD, JENNIFER RECTOR (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RECTOR
Last Name:BYRD
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 1:6002 DAWN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8623
Mailing Address - Country:US
Mailing Address - Phone:336-665-9266
Mailing Address - Fax:
Practice Address - Street 1:6002 DAWN RIDGE TRL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8623
Practice Address - Country:US
Practice Address - Phone:336-665-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13947OtherBLUE CROSSBLUE SHIELD
NC3403407Medicaid