Provider Demographics
NPI:1811277411
Name:JACQUELYN HARTMAN, LPC, PLLC
Entity type:Organization
Organization Name:JACQUELYN HARTMAN, LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART AND PLAY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:919-602-5797
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0116
Mailing Address - Country:US
Mailing Address - Phone:919-602-5797
Mailing Address - Fax:919-269-7761
Practice Address - Street 1:815 N ARENDELL AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2305
Practice Address - Country:US
Practice Address - Phone:919-602-5797
Practice Address - Fax:919-269-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty