Provider Demographics
NPI:1912179714
Name:WISEMAN, JAMIE CHRISCOE
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:CHRISCOE
Last Name:WISEMAN
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-0870
Mailing Address - Country:US
Mailing Address - Phone:910-585-0688
Mailing Address - Fax:
Practice Address - Street 1:7900 TRIAD CENTER
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9086
Practice Address - Country:US
Practice Address - Phone:336-931-1815
Practice Address - Fax:336-931-1801
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health