Individual
JESSE JACOB LILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
5000 COUNTRY CLUB RD., WINSTON SALEM, NC 27104
(336) 714-5478
Mailing address
1122 MELROSE ST, WINSTON SALEM, NC 27103-4437
(336) 722-8235
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6731
NC
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
03/24/2008
Last updated
03/24/2008
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