Provider Demographics
NPI:1588198113
Name:MCCAY, JILLIAN (MAED, LPC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MCCAY
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 FALLOWATER LN STE C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0949
Mailing Address - Country:US
Mailing Address - Phone:540-989-1383
Mailing Address - Fax:
Practice Address - Street 1:5401 FALLOWATER LN STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0949
Practice Address - Country:US
Practice Address - Phone:540-989-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional