Provider Demographics
NPI:1063748705
Name:PENNINGTON, JENNIFER MARTIN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARTIN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ROBYN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MA, EDS,LCMHCS
Mailing Address - Street 1:2925 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7269
Mailing Address - Country:US
Mailing Address - Phone:980-484-2111
Mailing Address - Fax:704-259-0480
Practice Address - Street 1:2925 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7269
Practice Address - Country:US
Practice Address - Phone:980-484-2111
Practice Address - Fax:704-259-0480
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7597101YP2500X
NC7957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional