Provider Demographics
NPI:1588149058
Name:PENNINGTON, JEANIE M (CDCA)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:M
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 RED FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8303
Mailing Address - Country:US
Mailing Address - Phone:614-969-8002
Mailing Address - Fax:
Practice Address - Street 1:1255 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1004
Practice Address - Country:US
Practice Address - Phone:740-844-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)