Healthcare Provider Details

I. General information

NPI: 1598903544
Provider Name (Legal Business Name): JEREMY GARELD ENZOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 GREEN LANTERN ST
RALEIGH NC
27613-4545
US

IV. Provider business mailing address

8203 GREEN LANTERN ST APT 106
RALEIGH NC
27613-4597
US

V. Phone/Fax

Practice location:
  • Phone: 984-233-5431
  • Fax:
Mailing address:
  • Phone: 919-561-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6110
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: