Basic Information
| Provider Information | |||||||||
| NPI: | 1134208804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MSW, LCSW, C-CATODSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 BONNIE LANE | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285865501 | ||||||||
| FaxNumber: | 8285863965 | ||||||||
| Practice Location | |||||||||
| Address1: | 91 TIMBERLANE RD | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287867927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284541098 | ||||||||
| FaxNumber: | 8284549242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6106248 | 05 | NC | MEDICAID |