Healthcare Provider Details

I. General information

NPI: 1093626939
Provider Name (Legal Business Name): REBECCA JOLLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WOOSTER RD
SOUTHERN PINES NC
28387-2354
US

IV. Provider business mailing address

187 MAGNOLIA HILL DR
CARTHAGE NC
28327-9638
US

V. Phone/Fax

Practice location:
  • Phone: 509-201-0316
  • Fax:
Mailing address:
  • Phone: 509-201-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: