Provider Demographics
NPI:1063122505
Name:FARMER, JEANNETTE (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:
Last Name:FARMER
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 1:1208 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9505
Mailing Address - Country:US
Mailing Address - Phone:252-320-2638
Mailing Address - Fax:
Practice Address - Street 1:1208 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9505
Practice Address - Country:US
Practice Address - Phone:252-320-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty