Provider Demographics
NPI:1740561265
Name:ELLER, JENNIFER H (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:ELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3902
Mailing Address - Country:US
Mailing Address - Phone:919-741-8537
Mailing Address - Fax:
Practice Address - Street 1:72103 MOSELEY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8574
Practice Address - Country:US
Practice Address - Phone:919-741-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical