Individual
MR. JIM TEDROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
212 RIDGE STREET, SMITHFIELD, NC 27577
(919) 751-9120
Mailing address
212 RIDGE STREET, SMITHFIELD, NC 27577
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
858 NC
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-1693916
TAX ID
NC
05
—
6107238
—
NC
Enumeration date
04/03/2007
Last updated
07/09/2007
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