Individual
JENNA PERUSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
108 BLYTHE MILL RD, WAXHAW, NC 28173-7696
(704) 618-5370
Mailing address
108 BLYTHE MILL RD, WAXHAW, NC 28173-7696
(704) 618-5370
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14219
NC
101YM0800X
Mental Health Counselor
A14219
NC
Other
Enumeration date
08/13/2018
Last updated
11/24/2021
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