Provider Demographics
NPI:1346859774
Name:CORY, JAIMIE SOPHIA (LCMHC)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:SOPHIA
Last Name:CORY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:KIMBLE
Other - Last Name:CORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2412 LAKE BRANDT PL APT A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2087
Mailing Address - Country:US
Mailing Address - Phone:713-444-5293
Mailing Address - Fax:
Practice Address - Street 1:3305 HEALY DR UNIT B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1406
Practice Address - Country:US
Practice Address - Phone:336-448-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health