Healthcare Provider Details

I. General information

NPI: 1003124710
Provider Name (Legal Business Name): JILLIAN VANDEGRIFT LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CUMBERLAND AVE STE 104
ASHEVILLE NC
28801-2206
US

IV. Provider business mailing address

40 GREEN HILL AVE
ASHEVILLE NC
28806-1714
US

V. Phone/Fax

Practice location:
  • Phone: 828-774-6892
  • Fax:
Mailing address:
  • Phone: 828-774-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA13795
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13795
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: