Provider Demographics
NPI:1487046074
Name:PIANA, JENNIFER ISABEL (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ISABEL
Last Name:PIANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3500
Mailing Address - Country:US
Mailing Address - Phone:704-660-6854
Mailing Address - Fax:
Practice Address - Street 1:2353 CONCORD LAKE RD STE 160
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2892
Practice Address - Country:US
Practice Address - Phone:704-412-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC011473OtherNCSWB