=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598067852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNY ELIEEN TILFORD L.C.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2010
-----------------------------------------------------
Last Update Date | 05/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 N GREENSBORO ST STE C6
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-962-5133
-----------------------------------------------------
Fax | 919-445-0414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 SPARGER SPRINGS LN
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-491-2869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C007040
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------