Larson, Jennifer Rebekah

Larson, Jennifer Rebekah is an sole proprietor health care provider with primary practice located at 8406 Six Forks Rd Ste 101 , Raleigh NC 27615-3075. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Neuropsychologist. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is her primary health care specialty. Larson, Jennifer Rebekah can be contacted via phone (919) 473-6451.

Contact Information

Primary practice address
8406 Six Forks Rd Ste 101 Raleigh NC 27615-3075
Phone: (919) 473-6451
Fax: (844) 584-4207
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2648 North Carolina
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 2648 North Carolina

Profile Details

NPI number 1487665584
LBN Legal business name Larson, Jennifer Rebekah
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 11th, 2006
Last updated Oct 15th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487665584 NPPES
North Carolina Other 045GA BCBS
North Carolina MEDICAID 6000216 BCBS

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