Provider Demographics
NPI:1124698444
Name:JEROME, EMILY (MED, LCMHCA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JEROME
Suffix:
Gender:F
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHAPEL HILL RD STE J
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:048-391-9573
Practice Address - Street 1:302 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1289
Practice Address - Country:US
Practice Address - Phone:846-699-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health