Provider Demographics
NPI:1356157424
Name:LEDFORD, JILL (BA, LCDP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:BA, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 ELMWOOD AVE APT D9
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3380
Mailing Address - Country:US
Mailing Address - Phone:401-263-3565
Mailing Address - Fax:
Practice Address - Street 1:23 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3701
Practice Address - Country:US
Practice Address - Phone:401-789-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP01006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)