Provider Demographics
NPI:1770229163
Name:SCANGA, JENNA (LMHC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SCANGA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POINDEXTER DR UNIT 2406
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6437
Mailing Address - Country:US
Mailing Address - Phone:845-367-2464
Mailing Address - Fax:
Practice Address - Street 1:134 POINDEXTER DR UNIT 2406
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6437
Practice Address - Country:US
Practice Address - Phone:845-367-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health