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General NPI Number Information
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NPI Number | 1720887730
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Entity Type | Individual
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Provider Name | JAIDEN MEDLIN LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 208 MALLOY ST
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City | GOLDSBORO
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State | NC
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Zip | 27534-4478
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Country | US
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Telephone | 984-520-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 441 SCOTTS STORE RD
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City | MOUNT OLIVE
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State | NC
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Zip | 28365-5908
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Country | US
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Telephone | 910-298-1098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P021634
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License Number State | NC
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