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General NPI Number Information
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NPI Number | 1003374802
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Entity Type | Organization
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Legal Business Name | JILLIAN MARTINDALE, LCSW, PLLC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 10 N MAIN ST
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City | BURNSVILLE
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State | NC
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Zip | 28714-2925
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Country | US
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Telephone | 828-263-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 346 HUNTER ST
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City | BURNSVILLE
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State | NC
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Zip | 28714-7137
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Country | US
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Telephone | 828-263-4467
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JILLIAN K MARTINDALE
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Credential | LCSW
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Telephone | 828-263-4467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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