Provider Demographics
NPI:1356630909
Name:LABONTE, JENNIFER A (MA, LCMHCS, LCAS,CCS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LABONTE
Suffix:
Gender:F
Credentials:MA, LCMHCS, LCAS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 ROBERT PORCHER WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2190
Mailing Address - Country:US
Mailing Address - Phone:336-389-6464
Mailing Address - Fax:
Practice Address - Street 1:3802 ROBERT PORCHER WAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2190
Practice Address - Country:US
Practice Address - Phone:919-332-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3363101YA0400X
NCS8238101YP2500X
NCCCS-20543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356630909Medicaid
NC182K5OtherBCBS
NC1356630909OtherHUMANA
1356630909OtherUBH/OPTUM
1356630909OtherCIGNA
NC600782-093OtherMAGELLAN