Provider Demographics
NPI:1073228110
Name:WEYANT, JENNIFER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEYANT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8028
Mailing Address - Country:US
Mailing Address - Phone:336-383-1665
Mailing Address - Fax:336-822-9463
Practice Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8028
Practice Address - Country:US
Practice Address - Phone:336-383-1665
Practice Address - Fax:336-822-9463
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty