Provider Demographics
NPI:1215111646
Name:SIPP, JENNIFER E (MA, LPA, HSP-PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SIPP
Suffix:
Gender:F
Credentials:MA, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 NORTHCROSS CENTER CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7302
Mailing Address - Country:US
Mailing Address - Phone:704-896-8688
Mailing Address - Fax:704-353-7029
Practice Address - Street 1:9835 NORTHCROSS CENTER CT
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7302
Practice Address - Country:US
Practice Address - Phone:704-896-8688
Practice Address - Fax:704-353-7029
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3836103TC2200X, 103T00000X, 103TF0000X, 103TM1800X, 103TB0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral