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General NPI Number Information
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NPI Number | 1689649857
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Entity Type | Individual
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Provider Name | JEANETTA SHEPPARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 301 ANDREWS AVENUE UNITED STATES ARMY SUBSTANCE ABUSE PROGRAM
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City | FORT RUCKER
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State | AL
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Zip | 36362-5105
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Country | US
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Telephone | 334-255-7918
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Fax | 334-255-7617
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Provider Business Mailing Address
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Address Line | 301 ANDREWS AVE.
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City | FORT RUCKER
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State | AL
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Zip | 36362-5105
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Country | US
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Telephone | 334-255-7918
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Fax | 334-255-7617
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP867
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ICADC6435
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7254
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2027C
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License Number State | AL
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