Provider Demographics
NPI:1003124710
Name:VANDEGRIFT, JILLIAN (LPCA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:VANDEGRIFT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GREEN HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1714
Mailing Address - Country:US
Mailing Address - Phone:828-774-6892
Mailing Address - Fax:
Practice Address - Street 1:30 CUMBERLAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2206
Practice Address - Country:US
Practice Address - Phone:828-774-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
NCA13795101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional