Provider Demographics
NPI:1255944690
Name:JUMP COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:JUMP COUNSELING AND CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGOOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPBH,MPC,LCASA,CADC
Authorized Official - Phone:910-224-3562
Mailing Address - Street 1:2958 DEEP COVE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2522
Mailing Address - Country:US
Mailing Address - Phone:910-224-3562
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1336
Practice Address - Country:US
Practice Address - Phone:470-296-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty