MEDICARE: JESSICA MATLOCK LCMHC

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	101YM0800X	Mental Health Counselor	14153	NC

General Provider Information

NPI Number	:	1801374731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MATLOCK LCMHC

Provider Business Mailing Address
First Line	:	4154 MENDENHALL OAKS PKWY STE 101
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8426
Country	:	US
Telephone Number	:	336-884-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4154 MENDENHALL OAKS PKWY STE 101
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8426
Country	:	US
Telephone Number	:	336-884-9510
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	05/01/2025

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