Healthcare Provider Details

I. General information

NPI: 1720417645
Provider Name (Legal Business Name): JILLIAN LADONICA SESSOMS LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ASHELAND AVE
ASHEVILLE NC
28801
US

IV. Provider business mailing address

90 ASHELAND AVE.
ASHEVILLE NC
28801
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-2700
  • Fax: 828-254-1524
Mailing address:
  • Phone: 828-254-2700
  • Fax: 828-254-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3062
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: