Provider Demographics
NPI:1124406541
Name:JUSTICE, JAIMILY (M A)
Entity Type:Individual
Prefix:MS
First Name:JAIMILY
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 18TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1364
Mailing Address - Country:US
Mailing Address - Phone:828-327-6633
Mailing Address - Fax:828-327-3385
Practice Address - Street 1:255 18TH ST SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1364
Practice Address - Country:US
Practice Address - Phone:828-327-6633
Practice Address - Fax:828-327-3385
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist