Provider Demographics
NPI:1194701813
Name:HENNESSY, JOYCE DAVIS (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:DAVIS
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:DAVIS
Other - Last Name:DEVINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:6809 FAIRVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3336
Mailing Address - Country:US
Mailing Address - Phone:704-365-7777
Mailing Address - Fax:704-365-9256
Practice Address - Street 1:6809 FAIRVIEW ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3336
Practice Address - Country:US
Practice Address - Phone:704-365-7777
Practice Address - Fax:704-365-9256
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC41649OtherBCBS
2861431Medicare ID - Type Unspecified