Healthcare Provider Details

I. General information

NPI: 1508723289
Provider Name (Legal Business Name): JESSICA MILLER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SHOOK MA

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 3RD AVE NE
HICKORY NC
28601-5014
US

IV. Provider business mailing address

106 3RD AVE NE
HICKORY NC
28601-5014
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-9130
  • Fax: 828-322-7890
Mailing address:
  • Phone: 828-322-9130
  • Fax: 828-322-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: