Provider Demographics
NPI:1710366687
Name:JODI PROVINCE COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:JODI PROVINCE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:TILLEY
Authorized Official - Last Name:PROVINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-818-0733
Mailing Address - Street 1:1260 COLLEGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2700
Mailing Address - Country:US
Mailing Address - Phone:336-526-0073
Mailing Address - Fax:336-526-0036
Practice Address - Street 1:2587 PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:STATE ROAD
Practice Address - State:NC
Practice Address - Zip Code:28676-9318
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty