| Organization Name: | JEANNINE BODNER, LCSW, PLLC |
| NPI Number: | 1255792156 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNINE BODNER (LCSW/OWNER) |
| Mailing Address: | 630 Davidson Gateway Dr Suite 150f Davidson |
| State: | NC US |
| Postal Code: | 280367068 |
| Phone Number: | 7049957686 |
| Fax Number: | 7046594010 |
| NPI Enumeration Date: | 03/19/2016 |
| NPI Last Update Date: | 04/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C009794 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |