MEDICARE: MRS. TYLESHIA DANIELLE JENNINGS LMSW, 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
1	104100000X	Social Worker	14000	SC
2	104100000X	Social Worker	P014509	NC

General Provider Information

NPI Number	:	1043983729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TYLESHIA DANIELLE JENNINGS LMSW, LCSW-A

Provider Business Mailing Address
First Line	:	251 ANVIL DRAW PL
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-9241
Country	:	US
Telephone Number	:	843-254-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	980-288-9227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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