Healthcare Provider Details

I. General information

NPI: 1205700994
Provider Name (Legal Business Name): JAILYN S WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-2156
US

IV. Provider business mailing address

717 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-2156
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax: 800-822-8287
Mailing address:
  • Phone: 866-600-7598
  • Fax: 800-822-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: