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General NPI Number Information
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NPI Number | 1588781322
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Entity Type | Individual
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Provider Name | JENNIFER VENABLE-HUMPHREY LCSW, PIP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 23 WISTERIA PL
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City | MILLBROOK
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State | AL
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Zip | 36054-1819
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Country | US
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Telephone | 334-354-2418
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Fax |
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Provider Business Mailing Address
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Address Line | 6719 TAYLOR CIR
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City | MONTGOMERY
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State | AL
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Zip | 36117-7706
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Country | US
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Telephone | 334-954-6010
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Fax | 334-649-6399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05351464C
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License Number State | AL
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