Individual
JESSICA GRACE MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2172 N SALEM ST STE 105, APEX, NC 27523-6457
(919) 639-4360
Mailing address
65 CREEKSTONE CT, HOLLY SPRINGS, NC 27540-7111
(919) 745-0464
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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