Provider Demographics
NPI:1679300065
Name:FLEMONS, JENNA (LCMHCA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FLEMONS
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 1:2801 STONE ROCK DR APT 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5309
Mailing Address - Country:US
Mailing Address - Phone:954-614-4547
Mailing Address - Fax:
Practice Address - Street 1:620 W LANE ST STE 201&202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2194
Practice Address - Country:US
Practice Address - Phone:919-213-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLEM-3ZIHUR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health