Provider Demographics
NPI:1437735446
Name:RONEY, JESSICA MEAGAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEAGAN
Last Name:RONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 RUSSELL LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314-9244
Mailing Address - Country:US
Mailing Address - Phone:336-639-9217
Mailing Address - Fax:
Practice Address - Street 1:914 N ELM ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6319
Practice Address - Country:US
Practice Address - Phone:919-351-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15438101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor