Healthcare Provider Details

I. General information

NPI: 1376281550
Provider Name (Legal Business Name): JENNA MARISSA MCLEOD LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CENTRAL AVE STE A
ASHEVILLE NC
28801-2452
US

IV. Provider business mailing address

77 CENTRAL AVE STE A
ASHEVILLE NC
28801-2452
US

V. Phone/Fax

Practice location:
  • Phone: 828-778-2973
  • Fax:
Mailing address:
  • Phone: 828-778-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17403
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA17403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: