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Individual

JACKIE LYNN KUPPER

Active
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Individual

JACKIE LYNN KUPPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, CRC, LCAS, LPCA

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
00111147
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1581
NC
101YP2500X
Professional Counselor
A8786
NC

Other

Enumeration date
11/18/2010
Last updated
06/13/2012
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