Provider Demographics
NPI:1265577662
Name:JENNINGS, CAROL DIANNE (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:DIANNE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CHURCH STREET
Mailing Address - Street 2:SUITE 245
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3840
Mailing Address - Country:US
Mailing Address - Phone:847-492-9288
Mailing Address - Fax:
Practice Address - Street 1:708 CHURCH STREET
Practice Address - Street 2:SUITE 245
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:847-492-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634922OtherBLUE CROSS BLUE SHIELD