Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 102L00000X | Psychologist | 3836 | NC |
N | 103T00000X | Psychologist | 3836 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3836 | NC |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 3836 | NC |
N | 103TF0000X | Family Psychologist | 3836 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | 3836 | NC |
NPI | 1215111646 |
---|---|
Provider Name | Jennifer E Sipp |
First Address | Huntersville, NC 28078-7302 |
Second Address | Huntersville, NC 28078-7302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 24/02/2010 |