Provider Demographics
NPI:1780841130
Name:COKER, JENNFER KELLY (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:JENNFER
Middle Name:KELLY
Last Name:COKER
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 REGENCY PKWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8549
Mailing Address - Country:US
Mailing Address - Phone:919-467-3831
Mailing Address - Fax:919-467-1611
Practice Address - Street 1:2500 REGENCY PKWY
Practice Address - Street 2:SUITE 214
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8549
Practice Address - Country:US
Practice Address - Phone:919-467-3831
Practice Address - Fax:919-467-1611
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health