Provider Demographics
NPI:1487343927
Name:PENDER, JANICE (MS, LCASA)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PENDER
Suffix:
Gender:F
Credentials:MS, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 AIRPORT BLVD NW STE C
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9603
Mailing Address - Country:US
Mailing Address - Phone:252-265-3104
Mailing Address - Fax:252-296-9060
Practice Address - Street 1:2519 AIRPORT BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9603
Practice Address - Country:US
Practice Address - Phone:252-265-3104
Practice Address - Fax:252-296-9060
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28930101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)