Provider Demographics
NPI:1588644439
Name:DRISCOLL, JEANINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 DANIELS FARM RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7022
Mailing Address - Country:US
Mailing Address - Phone:919-563-0881
Mailing Address - Fax:
Practice Address - Street 1:1502 W NC HIGHWAY 54
Practice Address - Street 2:#406
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5571
Practice Address - Country:US
Practice Address - Phone:919-493-6300
Practice Address - Fax:919-493-6307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2376103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling