Healthcare Provider Details

I. General information

NPI: 1588781322
Provider Name (Legal Business Name): JENNIFER VENABLE-HUMPHREY LCSW, PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WISTERIA PL
MILLBROOK AL
36054-1819
US

IV. Provider business mailing address

6719 TAYLOR CIR
MONTGOMERY AL
36117-7706
US

V. Phone/Fax

Practice location:
  • Phone: 334-354-2418
  • Fax:
Mailing address:
  • Phone: 334-954-6010
  • Fax: 334-649-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05351464C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: