Provider Demographics
NPI:1740689306
Name:BANCROFT, JENNIFER COURTNEY (MA, NCC, LPCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COURTNEY
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 KING ST STE B
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4089
Mailing Address - Country:US
Mailing Address - Phone:828-670-8056
Mailing Address - Fax:828-670-8057
Practice Address - Street 1:159 KING ST STE B
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4089
Practice Address - Country:US
Practice Address - Phone:828-670-8056
Practice Address - Fax:828-670-8057
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional