Provider Demographics
NPI:1255781951
Name:BROCK, JENNIFER (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 DEAVER ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4240
Mailing Address - Country:US
Mailing Address - Phone:828-713-9899
Mailing Address - Fax:
Practice Address - Street 1:390 MERRIMON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1222
Practice Address - Country:US
Practice Address - Phone:828-713-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS2978101YA0400X
NCC0092261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)