Healthcare Provider Details

I. General information

NPI: 1144764648
Provider Name (Legal Business Name): JENA DENNIS CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4581 PEERLESS ST
BATON ROUGE LA
70811-5430
US

IV. Provider business mailing address

12500 OLD HAMMOND HWY APT G2
BATON ROUGE LA
70816-1091
US

V. Phone/Fax

Practice location:
  • Phone: 225-366-9548
  • Fax:
Mailing address:
  • Phone: 225-336-9548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5150
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16864
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: