Provider Demographics
NPI:1245969997
Name:STULCK, JENNIFER ANN (LCMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:STULCK
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2626
Mailing Address - Country:US
Mailing Address - Phone:781-541-0073
Mailing Address - Fax:
Practice Address - Street 1:363 GRAPHITE RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-9455
Practice Address - Country:US
Practice Address - Phone:781-541-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health