Provider Demographics
NPI:1740213156
Name:POPLIN, JIMMY VAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:VAN
Last Name:POPLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WEST MAIN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9723
Mailing Address - Country:US
Mailing Address - Phone:336-246-4542
Mailing Address - Fax:336-246-2364
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 508
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-264-9007
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional