Provider Demographics
NPI:1669131496
Name:PENNINGTON, CASSANDRA ANN HARTLEY (LCSW-A, LCAS-A MSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN HARTLEY
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LCSW-A, LCAS-A MSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:A
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-A, LCAS-A MSW
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 807
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-0807
Practice Address - Country:US
Practice Address - Phone:910-361-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27531101YA0400X
NCP0177351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
5874OtherHEALTH PARTNERS
NC236Medicaid
568946544OtherBCBS