| Doctor Name: | JACKIE LYNN KUPPER |
| NPI Number: | 1164724415 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CRC, LCAS, LPCA |
| License Number: | 00111147 |
| Business Practice Address: | 150 E Arlington Blvd Suite E. Greenville, NC - 278585019 |
| Business Phone Number: | 2523211568 |
| Business Fax Number: | |
| Mailing Address: | 2705 Carlisle Court, GREENVILLE |
| State: | NC |
| Postal Code: | 278585536 |
| Phone Number: | 2525603740 |
| Fax Number: | |
| NPI Enumeration Date: | 11/18/2010 |
| NPI Last Update Date: | 06/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 00111147 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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 |