Provider Demographics
NPI:1881607141
Name:PELLS, JENNIFER J (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:PELLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 PICKETT RD
Mailing Address - Street 2:STRUCTURE HOUSE
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6005
Mailing Address - Country:US
Mailing Address - Phone:919-313-3129
Mailing Address - Fax:919-490-0191
Practice Address - Street 1:3017 PICKETT RD
Practice Address - Street 2:STRUCTURE HOUSE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6005
Practice Address - Country:US
Practice Address - Phone:919-313-3129
Practice Address - Fax:919-490-0191
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical