Healthcare Provider Details

I. General information

NPI: 1720269665
Provider Name (Legal Business Name): JENNIFER R. ORDONEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LAMBS PATH WAY
CASTLE HAYNE NC
28429-6311
US

IV. Provider business mailing address

PO BOX 10399
WILMINGTON NC
28404-0399
US

V. Phone/Fax

Practice location:
  • Phone: 910-675-3533
  • Fax: 910-675-3405
Mailing address:
  • Phone: 910-675-3533
  • Fax: 910-675-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: