Healthcare Provider Details

I. General information

NPI: 1245743087
Provider Name (Legal Business Name): JAILENE NIEVES-MERCADO LCMHC, REAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PROVIDENCE RD STE 101
CHAPEL HILL NC
27514-2208
US

IV. Provider business mailing address

150 PROVIDENCE RD STE 101
CHAPEL HILL NC
27514-2208
US

V. Phone/Fax

Practice location:
  • Phone: 919-893-0386
  • Fax: 919-551-7604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: