Provider Demographics
NPI:1659517142
Name:ELMORE, JENNIFER MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:ELMORE
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 1:3421 CHEYENNE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7409
Mailing Address - Country:US
Mailing Address - Phone:919-538-1987
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD
Practice Address - Street 2:STE #105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7745
Practice Address - Country:US
Practice Address - Phone:919-538-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104113Medicaid