Provider Demographics
NPI:1235492927
Name:VENZIAN, JAMIE LYN (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:VENZIAN
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:MIILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMHC
Mailing Address - Street 1:1409 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5817
Mailing Address - Country:US
Mailing Address - Phone:704-492-1105
Mailing Address - Fax:
Practice Address - Street 1:1409 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5817
Practice Address - Country:US
Practice Address - Phone:704-492-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005067101YM0800X
NC10149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health