Provider Demographics
NPI:1326729302
Name:GILLEY, JESSICA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GILLEY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1656
Mailing Address - Country:US
Mailing Address - Phone:336-838-1644
Mailing Address - Fax:336-667-7720
Practice Address - Street 1:204 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3543
Practice Address - Country:US
Practice Address - Phone:336-838-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional