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General NPI Number Information
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NPI Number | 1194050435
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Entity Type | Organization
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Legal Business Name | JODI PROVINCE COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 1260 COLLEGE AVE STE 1
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City | WILKESBORO
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State | NC
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Zip | 28697-2700
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Country | US
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Telephone | 336-818-0733
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Fax | 336-818-0734
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Provider Business Mailing Address
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Address Line | 1260 COLLEGE AVE STE 1
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City | WILKESBORO
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State | NC
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Zip | 28697-2700
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Country | US
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Telephone | 336-818-0733
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Fax | 336-818-0734
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Authorized Official
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Title or Position | ORGANIZER/MEMBER
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Name | MRS. JODI TILLEY PROVINCE
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Credential | MA, LPC, NCC
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Telephone | 336-818-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5534
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License Number State | NC
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Taxonomy #2
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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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