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General NPI Number Information
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NPI Number | 1417252966
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Entity Type | Individual
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Provider Name | JENNIFER M MONTGOMERY PHARM.D., LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 120 UNIONVILLE INDIAN TRAIL RD W # 100
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5665
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Country | US
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Telephone | 704-438-9901
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 DAMASCUS DR
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City | MONROE
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State | NC
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Zip | 28110-9334
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Country | US
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Telephone | 704-681-2422
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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 | A21494
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19194
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License Number State | NC
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