Provider Demographics
NPI:1235350323
Name:MINOGUE, JILL M (LPCC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MINOGUE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LITTLE GEM DR
Mailing Address - Street 2:106
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2584
Mailing Address - Country:US
Mailing Address - Phone:502-381-0041
Mailing Address - Fax:
Practice Address - Street 1:1310 RAEFORD RD
Practice Address - Street 2:2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5085
Practice Address - Country:US
Practice Address - Phone:502-381-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100284760Medicaid