Individual
MRS. JENNIFER GWYNN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
103 MILLS ST, RICHLANDS, NC 28574-8307
(910) 938-1114
(910) 455-4038
Mailing address
657 BEN WILLIAMS RD, JACKSONVILLE, NC 28540-9202
(910) 455-4038
(910) 324-1426
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C004237
NC
Other
Enumeration date
02/07/2006
Last updated
11/30/2010
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