Provider Demographics
NPI:1801353537
Name:BROWN, JENNA LEIGH (LISW-CP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4117
Mailing Address - Country:US
Mailing Address - Phone:803-464-4416
Mailing Address - Fax:803-526-7067
Practice Address - Street 1:2645A HARDEE CV
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1893
Practice Address - Country:US
Practice Address - Phone:803-720-9465
Practice Address - Fax:803-526-7067
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical