Provider Demographics
NPI:1760031983
Name:HARVEY, JENNIFER KIM (LPCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KIM
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KIM
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:106 COLLIER PL APT 2C
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9603
Mailing Address - Country:US
Mailing Address - Phone:315-921-4346
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1029
Practice Address - Country:US
Practice Address - Phone:919-714-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health