Individual
JESSICA MARIE SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
335 COUNTY HOME RD, REIDSVILLE, NC 27320-9694
(336) 342-8316
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NC
101YP2500X
Professional Counselor
Primary
14633
NC
Other
Enumeration date
02/11/2019
Last updated
02/21/2024
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