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General NPI Number Information
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NPI Number | 1255230942
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Entity Type | Organization
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Legal Business Name | JWAY360 COMMUNITY SERVICES
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 900 OLD WINSTON RD STE 214
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City | KERNERSVILLE
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State | NC
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Zip | 27284-9965
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Country | US
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Telephone | 336-986-6688
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | KERNERSVILLE
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State | NC
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Zip | 27285-0246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER JACKSON
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Credential |
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Telephone | 336-986-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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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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