Provider Demographics
NPI:1922393719
Name:WYNN, JENNIFER MOYNIHAN (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MOYNIHAN
Last Name:WYNN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MOYNIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT, LCAS-A
Mailing Address - Street 1:910 CLAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9284
Mailing Address - Country:US
Mailing Address - Phone:919-926-8057
Mailing Address - Fax:
Practice Address - Street 1:1405 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1828
Practice Address - Country:US
Practice Address - Phone:919-926-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist