Healthcare Provider Details

I. General information

NPI: 1346859774
Provider Name (Legal Business Name): JAIMIE SOPHIA CORY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSHUA KIMBLE CORY

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W CONE BLVD STE 182
GREENSBORO NC
27408-4064
US

IV. Provider business mailing address

3802 NEW GARDEN CMNS
GREENSBORO NC
27410-2348
US

V. Phone/Fax

Practice location:
  • Phone: 336-962-2661
  • Fax: 336-827-2998
Mailing address:
  • Phone: 713-444-5293
  • Fax: 336-827-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10819
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: