Basic Information
| Provider Information | |||||||||
| NPI: | 1316037377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TART | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5904 RAINEYWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MEBANE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273027028 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272155756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362295905 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5470 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.