Provider Demographics
NPI:1477383388
Name:PENNINGTON, MADELINE MAE (LCSWA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MAE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 HERITAGE CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8796
Mailing Address - Country:US
Mailing Address - Phone:919-438-2167
Mailing Address - Fax:
Practice Address - Street 1:1756 HERITAGE CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8796
Practice Address - Country:US
Practice Address - Phone:919-438-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP021138104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker