Provider Demographics
NPI:1194071043
Name:SHEPHERD, JENNIFER R (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2166 MOSTELLER ESTATE AVE SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-3468
Mailing Address - Country:US
Mailing Address - Phone:980-241-6887
Mailing Address - Fax:
Practice Address - Street 1:2166 MOSTELLER ESTATE AVE SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3468
Practice Address - Country:US
Practice Address - Phone:980-241-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7761101YP2500X
VA0701010590101YP2500X
GALPC011749101YP2500X
NC7781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional