Provider Demographics
NPI:1003402769
Name:POOLE, JANAE (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:JANAE
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 TIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2355
Mailing Address - Country:US
Mailing Address - Phone:919-638-0631
Mailing Address - Fax:
Practice Address - Street 1:9121 ANSON WAY STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5857
Practice Address - Country:US
Practice Address - Phone:984-204-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12253A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist