Provider Demographics
NPI:1679378376
Name:THERAPIST JENNA, PLLC
Entity type:Organization
Organization Name:THERAPIST JENNA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:704-727-2890
Mailing Address - Street 1:11508 FALLING LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9129
Mailing Address - Country:US
Mailing Address - Phone:214-901-5902
Mailing Address - Fax:704-565-4165
Practice Address - Street 1:6060 PIEDMONT ROW DR S STE 511
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3887
Practice Address - Country:US
Practice Address - Phone:704-727-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty