Healthcare Provider Details

I. General information

NPI: 1831697333
Provider Name (Legal Business Name): JENNA DARA SNYDER LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WASHINGTON ST STE 101
GREENSBORO NC
27401-2993
US

IV. Provider business mailing address

301 E WASHINGTON ST STE 101
GREENSBORO NC
27401-2993
US

V. Phone/Fax

Practice location:
  • Phone: 336-333-6860
  • Fax: 336-275-1187
Mailing address:
  • Phone: 336-333-6860
  • Fax: 336-275-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: