Healthcare Provider Details

I. General information

NPI: 1831598226
Provider Name (Legal Business Name): JENNA MENDELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MARKET ST
GREENSBORO NC
27403-1830
US

IV. Provider business mailing address

PO BOX 26170 UNCG CAMPUS
GREENSBORO NC
27402-6170
US

V. Phone/Fax

Practice location:
  • Phone: 336-256-0061
  • Fax: 336-334-5754
Mailing address:
  • Phone: 336-334-5662
  • Fax: 336-334-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4646
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: