Provider Demographics
NPI:1942861489
Name:LENNON, COLLEEN (MED)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N KING CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1019
Mailing Address - Country:US
Mailing Address - Phone:919-395-6554
Mailing Address - Fax:207-955-5778
Practice Address - Street 1:7424 CHAPEL HILL RD STE 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5041
Practice Address - Country:US
Practice Address - Phone:919-395-6554
Practice Address - Fax:207-955-5778
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty