Healthcare Provider Details

I. General information

NPI: 1700524311
Provider Name (Legal Business Name): JENNIFER AMY HADDOCK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E FRANKLIN ST
ROCKINGHAM NC
28379-3627
US

IV. Provider business mailing address

402 HARRIS AVE
RAEFORD NC
28376-3112
US

V. Phone/Fax

Practice location:
  • Phone: 910-817-7417
  • Fax: 910-817-7218
Mailing address:
  • Phone: 910-875-5590
  • Fax: 901-875-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: