Provider Demographics
NPI:1598903544
Name:ENZOR, JEREMY GARELD (LPC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:GARELD
Last Name:ENZOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 GREEN LANTERN ST APT 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4597
Mailing Address - Country:US
Mailing Address - Phone:919-561-2124
Mailing Address - Fax:
Practice Address - Street 1:8224 GREEN LANTERN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4545
Practice Address - Country:US
Practice Address - Phone:984-233-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6110101YP2500X
NC7284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional