Individual
AUDREY ROSE JAENICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWA
Contact information
Practice address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 202-3155
Mailing address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
P107269
NC
Other
Enumeration date
03/14/2022
Last updated
04/25/2022
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