Healthcare Provider Details

I. General information

NPI: 1427419969
Provider Name (Legal Business Name): JENNIFER KOLB MA, LPCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 COX RD
GASTONIA NC
28054-0628
US

IV. Provider business mailing address

515 CLANTON RD
CHARLOTTE NC
28217-1309
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1558
  • Fax: 704-865-9908
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA12176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: