Provider Demographics
NPI:1487839247
Name:BIRCH, JENNIFER MCCLEES (EDS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MCCLEES
Last Name:BIRCH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 CRABBERRY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8219
Mailing Address - Country:US
Mailing Address - Phone:919-803-8947
Mailing Address - Fax:
Practice Address - Street 1:7406 CHAPEL HILL RD STE F
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5039
Practice Address - Country:US
Practice Address - Phone:919-233-7360
Practice Address - Fax:919-233-7361
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health