Provider Demographics
NPI:1891947321
Name:ENGELSTEIN, JODI WYNNE (LMHC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:WYNNE
Last Name:ENGELSTEIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 ALPINE CRYSTAL WAY STE 210B
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4188
Mailing Address - Country:US
Mailing Address - Phone:617-697-4432
Mailing Address - Fax:
Practice Address - Street 1:726 ALPINE CRYSTAL WAY
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4188
Practice Address - Country:US
Practice Address - Phone:617-697-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10919101YM0800X
FLMH16580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health