Individual
DR. JAKE EDWIN RICKETSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
405 WESTWOOD AVE, HIGH POINT, NC 27262-4325
(336) 887-7350
(336) 887-7353
Mailing address
405 WESTWOOD AVE, HIGH POINT, NC 27262-4325
(336) 887-7350
(336) 887-7353
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1167
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04492
BCBS PRIVATE INSURANCE
NC
01
—
21519
MEDCAST PRIVATE INSURANCE
NC
05
—
6000026
—
NC
Enumeration date
12/05/2006
Last updated
02/09/2012
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