Provider Demographics
NPI:1679399455
Name:ATWOOD, JE'MARA JANISHA
Entity type:Individual
Prefix:MS
First Name:JE'MARA
Middle Name:JANISHA
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 MARGELLINA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4086
Mailing Address - Country:US
Mailing Address - Phone:718-930-4026
Mailing Address - Fax:
Practice Address - Street 1:1300 BAXTER ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3053
Practice Address - Country:US
Practice Address - Phone:718-930-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician