Provider Demographics
NPI:1194581413
Name:LOREK, JILLIAN OLESON (LCMHCA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:OLESON
Last Name:LOREK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 NEW EDITION CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4449
Mailing Address - Country:US
Mailing Address - Phone:919-739-4121
Mailing Address - Fax:919-355-3048
Practice Address - Street 1:114 NEW EDITION CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4449
Practice Address - Country:US
Practice Address - Phone:919-739-4121
Practice Address - Fax:919-355-3048
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19767101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional