Active NPI
Jennifer Gwynn Brock, MSW, LCSW
- Professional Counselor
- Richlands, NC
National Provider Identifier
1609848100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C004237
- Practice address
- 103 Mills St
Richlands, NC 28574-8307 - Phone
- (910) 938-1114
- Fax
- (910) 455-4038
- NPI assigned
- Feb 7, 2006
- Last updated
- Nov 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C004237 | NC | Primary |
Addresses
Primary practice location
103 Mills St
Richlands, NC 28574-8307
Mailing address
657 Ben Williams Rd
Jacksonville, NC 28540-9202
Phone (910) 455-4038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C004237 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291075200000",
"number": "1609848100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "657 BEN WILLIAMS RD",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285409202",
"telephone_number": "910-455-4038",
"fax_number": "910-324-1426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 MILLS ST",
"city": "RICHLANDS",
"state": "NC",
"postal_code": "285748307",
"telephone_number": "910-938-1114",
"fax_number": "910-455-4038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "JENNIFER",
"middle_name": "GWYNN",
"name_prefix": "Mrs.",
"credential": "MSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-07",
"last_updated": "2010-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "C004237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richlands, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.