Provider Demographics
NPI:1194734525
Name:CALL CHANG, JENNIFER (MA, LPA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CALL CHANG
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537
Mailing Address - Country:US
Mailing Address - Phone:252-431-4418
Mailing Address - Fax:252-572-2418
Practice Address - Street 1:104 MARKET ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537
Practice Address - Country:US
Practice Address - Phone:252-431-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107348Medicaid