Healthcare Provider Details

I. General information

NPI: 1417252966
Provider Name (Legal Business Name): JENNIFER M MONTGOMERY PHARM.D., LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 UNIONVILLE INDIAN TRAIL RD W # 100
INDIAN TRAIL NC
28079-5665
US

IV. Provider business mailing address

2401 DAMASCUS DR
MONROE NC
28110-9334
US

V. Phone/Fax

Practice location:
  • Phone: 704-438-9901
  • Fax:
Mailing address:
  • Phone: 704-681-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21494
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: