| Jodi Province Counseling Services Pllc | |
|
2587 Pleasant Ridge Rd State Road NC 28676-9318 | |
| (336) 818-0733 | |
| Not Available |
| Full Name | Jodi Province Counseling Services Pllc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2587 Pleasant Ridge Rd, State Road, North Carolina |
| Authorized Official Name and Position | Jodi Tilley Province (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3368180733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi Province Counseling Services Pllc 1260 College Ave Suite 1 Wilkesboro NC 28697-2700 Ph: (336) 526-0073 | Jodi Province Counseling Services Pllc 2587 Pleasant Ridge Rd State Road NC 28676-9318 Ph: (336) 818-0733 |
| NPI Number | 1710366687 |
|---|---|
| Provider Enumeration Date | 05/26/2015 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710366687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |