Doctor Name: | JENNIFER C CONNOLLY |
NPI Number: | 1073862017 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PLCSW |
License Number: | P006709 |
Business Practice Address: | 725 N. Highland Ave 2nd Floor Winston-salem, NC - 271014206 |
Business Phone Number: | 3366078501 |
Business Fax Number: | 3367254030 |
Mailing Address: | 3210 Fairhill Drive, RALEIGH |
State: | NC |
Postal Code: | 276123215 |
Phone Number: | 9192560824 |
Fax Number: | 9192560833 |
NPI Enumeration Date: | 09/06/2012 |
NPI Last Update Date: | 09/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | P006709 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |