Provider Demographics
NPI:1518192806
Name:WEBSTER, JANE SUZANNE (PHD, RYT)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:SUZANNE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PHD, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1100
Mailing Address - Country:US
Mailing Address - Phone:252-292-0818
Mailing Address - Fax:
Practice Address - Street 1:2906 RIDGE RD NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1100
Practice Address - Country:US
Practice Address - Phone:252-292-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ZZ101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor