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NPI Code Detail

MEDICARE: MRS. JOYCE DAVIS HENNESSY MSW LCSW

MEDICARE: MRS. JOYCE DAVIS HENNESSY MSW LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerC000606NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
141649OTHERNCBCBS

General Provider Information

NPI Number : 1194701813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOYCE DAVIS HENNESSY MSW LCSW
Provider Business Mailing Address
First Line : 6809 FAIRVIEW ROAD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3336
Country : US
Telephone Number : 704-365-7777
Fax Number : 704-365-9256
Provider Business Practice Location Address
First Line : 6809 FAIRVIEW ROAD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3336
Country : US
Telephone Number : 704-365-7777
Fax Number : 704-365-9256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 10/26/2011

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