Provider Demographics
NPI:1548667983
Name:O'CONNELL, JENNIFER THOR (MA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:THOR
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:NC
Mailing Address - Zip Code:27920-0274
Mailing Address - Country:US
Mailing Address - Phone:919-280-5031
Mailing Address - Fax:252-995-3340
Practice Address - Street 1:41838 NC 12
Practice Address - Street 2:STE 104
Practice Address - City:AVON
Practice Address - State:NC
Practice Address - Zip Code:27915
Practice Address - Country:US
Practice Address - Phone:252-996-0706
Practice Address - Fax:252-995-3340
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14375101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health