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Organization

JODI PROVINCE COUNSELING SERVICES PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JODI TILLEY PROVINCE MA, LPC, NCC (ORGANIZER/MEMBER)
(336) 818-0733
Entity
Organization

Contact information

Practice address
1260 COLLEGE AVE STE 1, WILKESBORO, NC 28697-2700
(336) 818-0733
(336) 818-0734
Mailing address
1260 COLLEGE AVE STE 1, WILKESBORO, NC 28697-2700
(336) 818-0733
(336) 818-0734

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
5534
NC
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
144VW
BCBSNC
NC
05
6102745
NC
05
6103333
NC
05
6103527
NC
05
6105186
NC
05
6106369
NC
05
6107594
NC
05
6112147
NC
05
6112237
NC
Enumeration date
10/05/2009
Last updated
08/13/2024
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