Provider Demographics
NPI:1205139524
Name:LAMBERTH, JENNIFER R (MA LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LAMBERTH
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:LAMBERTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:805 WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4555
Mailing Address - Country:US
Mailing Address - Phone:910-484-4061
Mailing Address - Fax:
Practice Address - Street 1:805 WESTMONT DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4555
Practice Address - Country:US
Practice Address - Phone:910-484-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7019A106H00000X
NC1399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105309Medicaid