Provider Demographics
NPI:1649255134
Name:WEAVER, JEAN E (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:E
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 OLD SALEM RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1226
Mailing Address - Country:US
Mailing Address - Phone:937-890-3851
Mailing Address - Fax:
Practice Address - Street 1:42 E RAHN RD
Practice Address - Street 2:#209
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5459
Practice Address - Country:US
Practice Address - Phone:937-439-1930
Practice Address - Fax:937-438-6788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-377101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor