Healthcare Provider Details

I. General information

NPI: 1174302491
Provider Name (Legal Business Name): K'NEADEE LESTER-JACKSON MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N MAIN ST
TROY NC
27371-3058
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 910-572-3681
  • Fax: 910-572-5579
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018752
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: