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Individual

JENNIFER TISDALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
136 US 70 HWY E, GARNER, NC 27529-3982
(919) 791-5611
Mailing address
1107 MORDECAI DR APT 202, RALEIGH, NC 27604-1357
(919) 413-7900

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
PO13258
NC
1041C0700X
Clinical Social Worker
C017933
NC

Other

Enumeration date
05/23/2019
Last updated
12/26/2024
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