Basic Information
| Provider Information | |||||||||
| NPI: | 1821615980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUEVARA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH ST STE 316 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026364409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215B MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527477824 | ||||||||
| FaxNumber: | 9105770383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2020 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-26769 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | P014755 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.