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General NPI Number Information
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NPI Number | 1942861489
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Entity Type | Individual
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Provider Name | COLLEEN LENNON MED
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 7424 CHAPEL HILL RD STE 209
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City | RALEIGH
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State | NC
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Zip | 27607-5041
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Country | US
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Telephone | 919-395-6554
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Fax | 207-955-5778
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Provider Business Mailing Address
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Address Line | 1209 N KING CHARLES RD
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City | RALEIGH
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State | NC
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Zip | 27610-1019
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Country | US
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Telephone | 919-395-6554
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Fax | 207-955-5778
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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 | A14920
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License Number State | NC
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