Provider Demographics
NPI:1336592344
Name:ONG, JENNIFER ISABELLE (PHD, MS, MED)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ISABELLE
Last Name:ONG
Suffix:
Gender:F
Credentials:PHD, MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BETHESDA PL STE 301
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3325
Mailing Address - Country:US
Mailing Address - Phone:336-501-8044
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL STE 301
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3325
Practice Address - Country:US
Practice Address - Phone:336-501-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional