Provider Demographics
NPI:1265995344
Name:ANSTEAD, JACINDA LELA
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:LELA
Last Name:ANSTEAD
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 1:930 BENJAMIN BENSEN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-2039
Mailing Address - Country:US
Mailing Address - Phone:252-382-0009
Mailing Address - Fax:
Practice Address - Street 1:5587 GARDEN VILLAGE WAY STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8590
Practice Address - Country:US
Practice Address - Phone:336-310-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0132991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical