Provider Demographics
NPI:1417252966
Name:MONTGOMERY, JENNIFER M (PHARMD, LCMHCA)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 DAMASCUS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-9334
Mailing Address - Country:US
Mailing Address - Phone:704-681-2422
Mailing Address - Fax:
Practice Address - Street 1:120 UNIONVILLE INDIAN TRAIL RD W # 100
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5665
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21494101YM0800X
NC19194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health