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NPI Code Detail

MEDICARE: JENICE THOMPSON FOREMAN LCSW-A

MEDICARE:   JENICE THOMPSON FOREMAN  LCSW-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP010399NC

General Provider Information

NPI Number : 1023561867
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENICE THOMPSON FOREMAN LCSW-A
Provider Business Mailing Address
First Line : 7736 WATERFORD LK DR APT 14355
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-7485
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2300 SARDIS RD N STE M
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7712
Country : US
Telephone Number : 704-344-0491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2016
Last Update Date : 12/08/2017

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Directions to “ JENICE THOMPSON FOREMAN LCSW-A” Practice Location

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