Provider Demographics
NPI:1336790633
Name:CANTERBURY, JENNA BONNELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:BONNELL
Last Name:CANTERBURY
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 1:926 CLEVELAND ST APT 4208
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4651
Mailing Address - Country:US
Mailing Address - Phone:229-560-6009
Mailing Address - Fax:
Practice Address - Street 1:926 CLEVELAND ST APT 4208
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4651
Practice Address - Country:US
Practice Address - Phone:229-560-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14933101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health