Provider Demographics
NPI:1154931822
Name:JAIN, VERNIKA (MS, EDS, LCMHCA, NC)
Entity type:Individual
Prefix:MISS
First Name:VERNIKA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MS, EDS, LCMHCA, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 QUEENS BLVD APT 8E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4209
Mailing Address - Country:US
Mailing Address - Phone:718-261-0422
Mailing Address - Fax:
Practice Address - Street 1:510 NORTHGATE PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3486
Practice Address - Country:US
Practice Address - Phone:888-446-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health