Provider Demographics
NPI:1962131953
Name:JEWELL, NATALIE MARIE (LCMHCA)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MARIE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3864
Mailing Address - Country:US
Mailing Address - Phone:133-665-5496
Mailing Address - Fax:
Practice Address - Street 1:206 FAIR OAKS LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3178
Practice Address - Country:US
Practice Address - Phone:336-745-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health