Provider Demographics
NPI:1629782008
Name:BYNUM, JENNIFER M (CIT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BYNUM
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MIG COUNSELING
Mailing Address - Street 2:136 WEST STREET
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312
Mailing Address - Country:US
Mailing Address - Phone:984-237-3579
Mailing Address - Fax:
Practice Address - Street 1:MIG COUNSELING
Practice Address - Street 2:136 WEST STREET
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:984-237-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811565377Medicaid