Jennifer Dianne Conrad

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A18124 Issued in NC

Practice address

7621 Purfoy Rd Ste 105B
Fuquay Varina, NC 27526-6985

Phone

(833) 749-4584

NPI assigned

May 6, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• GC Creative Counseling, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Selma, NC
  • NPI 1922991447
  NPD Authorized official
• Phoenix Partners NC

  • Mental Health Counselor
  • Fuquay Varina, NC
  • NPI 1598363780
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1447007570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 N SUMNER ST",
            "city": "SELMA",
            "state": "NC",
            "postal_code": "275762530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7621 PURFOY RD STE 105B",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275266985",
            "telephone_number": "833-749-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRAD",
        "first_name": "JENNIFER",
        "middle_name": "DIANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A18124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Healthcare Solutions Inc
• Community Healthcare Solutions Inc.
• Christian Grant Conaway, DPT
• Heather Conklin, COTA
• Marissa Lee Conniff, MS, CCC-SLP
• Melissa-Rose Djinia Cook, MS, CCC-SLP
• Rebecca Copell
• Country Living Retirement Home
• County of Wake
• Courage to Change Mental Health and Wellness PLLC

• Mental Health Counselor in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.