Provider Demographics
NPI:1366888216
Name:GREENE, JENNIFER JO (MA, LPCA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BAMBOO RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9673
Mailing Address - Country:US
Mailing Address - Phone:828-266-9703
Mailing Address - Fax:828-264-0370
Practice Address - Street 1:3505 BAMBOO RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9673
Practice Address - Country:US
Practice Address - Phone:828-266-9703
Practice Address - Fax:828-264-0370
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPCA# 8021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor