Healthcare Provider Details

I. General information

NPI: 1740401447
Provider Name (Legal Business Name): JENNIFER LYNNE HORNICK BA, BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 256A
TRIADELPHIA WV
26059-9725
US

IV. Provider business mailing address

PO BOX 24
BEECH BOTTOM WV
26030-0024
US

V. Phone/Fax

Practice location:
  • Phone: 304-547-9197
  • Fax: 304-547-9198
Mailing address:
  • Phone: 304-394-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAP00940521
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: