Provider Demographics
NPI:1508093964
Name:TARTAMELLA, JENNIFER MAYO
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAYO
Last Name:TARTAMELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 CANNADYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTRELL
Mailing Address - State:NC
Mailing Address - Zip Code:27544-7700
Mailing Address - Country:US
Mailing Address - Phone:919-690-1996
Mailing Address - Fax:
Practice Address - Street 1:200 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2762
Practice Address - Country:US
Practice Address - Phone:919-693-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional