Provider Demographics
NPI:1104953603
Name:BADDOUR, JENNIFER L (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BADDOUR
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Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:109 CONNER DRIVE
Mailing Address - Street 2:BUILDING 3, SUITE 203
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-929-3739
Mailing Address - Fax:919-929-5579
Practice Address - Street 1:109 CONNER DRIVE
Practice Address - Street 2:BUILDING 3, SUITE 203
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-929-3739
Practice Address - Fax:919-929-5579
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical