Individual
JACKIE LYNN KUPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CRC, LCAS, LPCA
Contact information
Practice address
150 E ARLINGTON BLVD SUITE E., GREENVILLE, NC 27858-5019
(252) 321-1568
Mailing address
2705 CARLISLE COURT, GREENVILLE, NC 27858-5536
(252) 560-3740
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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