Provider Demographics
NPI:1639594765
Name:ROWE, JAYMIE LYN (LMFT)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:LYN
Last Name:ROWE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-9005
Mailing Address - Fax:
Practice Address - Street 1:873 NORTHERN DR NW
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-6513
Practice Address - Country:US
Practice Address - Phone:828-464-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP012001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1712OtherSTATE OF NORTH CAROLINA MARRIAGE AND FAMILY LICENSURE BOARD