Basic Information
| Provider Information | |||||||||
| NPI: | 1740401447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORNICK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | BA, BSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24 | ||||||||
| Address2: | |||||||||
| City: | BEECH BOTTOM | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260300024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043945466 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | RR 1 BOX 256A | ||||||||
| Address2: | |||||||||
| City: | TRIADELPHIA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260599725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045479197 | ||||||||
| FaxNumber: | 3045479198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | AP00940521 | WV | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.