Provider Demographics
NPI:1932169786
Name:MISCHLER, JENNIFER CHRISTINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:MISCHLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 OAK LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-8165
Mailing Address - Country:US
Mailing Address - Phone:336-492-6133
Mailing Address - Fax:
Practice Address - Street 1:190 KIMEL PARK DR
Practice Address - Street 2:122Q
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-3296
Practice Address - Fax:336-760-5484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical