Healthcare Provider Details

I. General information

NPI: 1447773981
Provider Name (Legal Business Name): JADE WOODARD PYBURN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WOOTEN BLVD SW STE K
WILSON NC
27893-4464
US

IV. Provider business mailing address

805 TRUE VINE RD NE
PIKEVILLE NC
27863-8225
US

V. Phone/Fax

Practice location:
  • Phone: 770-527-7966
  • Fax: 252-291-2890
Mailing address:
  • Phone: 919-222-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP011438
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: