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General NPI Number Information
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NPI Number | 1194438820
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Entity Type | Individual
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Provider Name | RENEE JACOBSEN BIRCH LCMHC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 17015 KENTON DR
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City | CORNELIUS
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State | NC
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Zip | 28031-5661
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Country | US
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Telephone | 704-970-2471
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Fax |
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Provider Business Mailing Address
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Address Line | 9517 GUILDBROOK RD
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City | DAVIDSON
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State | NC
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Zip | 28036-9613
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Country | US
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Telephone | 704-970-2471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13968
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License Number State | NC
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