Provider Demographics
NPI:1194035022
Name:RATAJCZAK, JENNIFER KAY (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:RATAJCZAK
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 PARK VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4660
Mailing Address - Country:US
Mailing Address - Phone:513-479-2629
Mailing Address - Fax:
Practice Address - Street 1:2024 E SEVENTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3336
Practice Address - Country:US
Practice Address - Phone:704-837-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor