Provider Demographics
NPI:1952704926
Name:PAYNE, JENNIFER JEAN (LPC, CCMC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC, CCMC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:RHODES-WEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 JULIAN R ALLSBROOK HWY
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4611
Mailing Address - Country:US
Mailing Address - Phone:252-537-7458
Mailing Address - Fax:252-541-2039
Practice Address - Street 1:544 J R ALLSBROOK HWY
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4611
Practice Address - Country:US
Practice Address - Phone:252-537-7458
Practice Address - Fax:252-537-7458
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8616101Y00000X
101YM0800X
NC8616101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional