Healthcare Provider Details

I. General information

NPI: 1215139969
Provider Name (Legal Business Name): JENNY LYNN HOVANEC M.S.W. - L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 CARMEL EXECUTIVE PARK DR SUITE 210
CHARLOTTE NC
28226-8275
US

IV. Provider business mailing address

7401 CARMEL EXECUTIVE PARK DR SUITE 210
CHARLOTTE NC
28226-8275
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-8414
  • Fax: 704-752-8104
Mailing address:
  • Phone: 704-752-8414
  • Fax: 704-752-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002878
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: