Provider Demographics
NPI:1194316679
Name:GARDNER, JEWELL BARNES (MSW, LCSWA)
Entity type:Individual
Prefix:MRS
First Name:JEWELL
Middle Name:BARNES
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NC
Mailing Address - Zip Code:27806-0441
Mailing Address - Country:US
Mailing Address - Phone:252-814-7128
Mailing Address - Fax:
Practice Address - Street 1:417 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4827
Practice Address - Country:US
Practice Address - Phone:833-781-6474
Practice Address - Fax:252-362-0336
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015622104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker