Provider Demographics
NPI:1356617724
Name:GOMES, JENNIFER DOWD (MSW, P-LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DOWD
Last Name:GOMES
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5019
Mailing Address - Country:US
Mailing Address - Phone:252-551-5544
Mailing Address - Fax:252-551-5625
Practice Address - Street 1:150 E ARLINGTON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5019
Practice Address - Country:US
Practice Address - Phone:252-551-5544
Practice Address - Fax:252-551-5625
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0065321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical