MEDICARE: MS. JILL CARLTON MS,NCC,LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	8398	NC
2	101YM0800X	Mental Health Counselor	8398	NC
3	101YP2500X	Professional Counselor	8398	NC

General Provider Information

NPI Number	:	1578802682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL CARLTON MS,NCC,LPC

Provider Business Mailing Address
First Line	:	5195 ASHGROVE DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9259
Country	:	US
Telephone Number	:	336-686-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5195 ASHGROVE DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9259
Country	:	US
Telephone Number	:	336-686-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	02/08/2013

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