Provider Demographics
NPI:1336466978
Name:COCKBURN, JENNIFER KRISTIN (LCMHCA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KRISTIN
Last Name:COCKBURN
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 1:1323 WINSTEAD PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8024
Mailing Address - Country:US
Mailing Address - Phone:336-419-9301
Mailing Address - Fax:
Practice Address - Street 1:1323 WINSTEAD PL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8024
Practice Address - Country:US
Practice Address - Phone:336-419-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A17563101Y00000X
NCA17563101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health