Provider Demographics
NPI:1467811380
Name:CHANG, JEANIE YU-GIN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JEANIE
Middle Name:YU-GIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:JEANIE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:901 KILDAIRE FARM RD # C1-C
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3937
Mailing Address - Country:US
Mailing Address - Phone:919-867-1191
Mailing Address - Fax:
Practice Address - Street 1:901 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3937
Practice Address - Country:US
Practice Address - Phone:919-867-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11031A106H00000X
NC1872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist