Provider Demographics
NPI:1275205205
Name:PERRINE, JAHNA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAHNA
Middle Name:MARIE
Last Name:PERRINE
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 1:2820 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3824
Mailing Address - Country:US
Mailing Address - Phone:575-491-4996
Mailing Address - Fax:
Practice Address - Street 1:280 DAVID L GOLDFEIN ST BLDG 23
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-7061
Practice Address - Fax:575-572-1523
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-01271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical