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General NPI Number Information
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NPI Number | 1417598194
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Entity Type | Individual
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Provider Name | JENNIFER N OSBORNE
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 257 CHURCH ST NE
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City | CONCORD
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State | NC
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Zip | 28025-4763
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Country | US
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Telephone | 248-778-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ARCHIBALD RD
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City | CONCORD
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State | NC
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Zip | 28025-8881
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Country | US
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Telephone | 248-778-6306
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401010060
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 15555
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License Number State | NC
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