Provider Demographics
NPI:1619258258
Name:GUILBAULT, JEANNE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:GUILBAULT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2424
Mailing Address - Country:US
Mailing Address - Phone:910-508-7822
Mailing Address - Fax:
Practice Address - Street 1:114 PINE ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2424
Practice Address - Country:US
Practice Address - Phone:910-508-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104873Medicaid