Provider Demographics
NPI:1356488878
Name:CHRISTENSEN, JEFFREY JAY (LMFT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAY
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:CHRISTENSEN
Other - Middle Name:FAMILY
Other - Last Name:THERAPY, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1529 MAIN DIVIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6194
Mailing Address - Country:US
Mailing Address - Phone:919-757-3440
Mailing Address - Fax:919-562-5696
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5026
Practice Address - Country:US
Practice Address - Phone:919-757-3440
Practice Address - Fax:919-562-5696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105161Medicaid