| Jodi Province Counseling Services, Pllc | |
|
1260 College Ave Ste 1 Wilkesboro NC 28697-2700 | |
| (336) 818-0733 | |
| (336) 818-0734 |
| Full Name | Jodi Province Counseling Services, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1260 College Ave Ste 1, Wilkesboro, North Carolina |
| Authorized Official Name and Position | Jodi Tilley Province (ORGANIZER/MEMBER) |
| Authorized Official Contact | 3368180733 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi Province Counseling Services, Pllc 1260 College Ave Ste 1 Wilkesboro NC 28697-2700 Ph: (336) 818-0733 | Jodi Province Counseling Services, Pllc 1260 College Ave Ste 1 Wilkesboro NC 28697-2700 Ph: (336) 818-0733 |
| NPI Number | 1194050435 |
|---|---|
| Provider Enumeration Date | 10/05/2009 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 3678726569 |
|---|---|
| Medicare Enrollment ID | O20121228000228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194050435 | NPI | - | NPPES |
| 6107594 | Medicaid | NC | |
| 6105186 | Medicaid | NC | |
| 6112237 | Medicaid | NC | |
| 6102745 | Medicaid | NC | |
| 6103333 | Medicaid | NC | |
| 6103527 | Medicaid | NC | |
| 6112147 | Medicaid | NC | |
| 144VW | Other | NC | BCBSNC |
| 6106369 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5534 (North Carolina) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Amber G Dillard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245288828 PECOS PAC ID: 6406869155 Enrollment ID: I20060724000245 |
| Provider Name | Nicole M Englebright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588055537 PECOS PAC ID: 4284908641 Enrollment ID: I20170922002639 |
| Provider Name | Nicholas Alexander Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902302292 PECOS PAC ID: 7911326699 Enrollment ID: I20200929003293 |
| Provider Name | Caitlin Josey Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073160693 PECOS PAC ID: 8729407044 Enrollment ID: I20201006000039 |
| Provider Name | Erica Marie Falls |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023684206 PECOS PAC ID: 3577935618 Enrollment ID: I20230217001998 |
| Provider Name | Morganne Alexandra Foley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326658378 PECOS PAC ID: 1153794987 Enrollment ID: I20230227001372 |
| Provider Name | Melissa H Casstevens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043787690 PECOS PAC ID: 6002264306 Enrollment ID: I20231128000228 |
| Provider Name | Zoee Amber Wood Byrd |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699438119 PECOS PAC ID: 9032568852 Enrollment ID: I20231205003412 |
| Provider Name | Lorenz Vassa Falls |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205409935 PECOS PAC ID: 2961851704 Enrollment ID: I20231206000215 |
| Provider Name | Vanessa Marie Doran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629596663 PECOS PAC ID: 3274984208 Enrollment ID: I20240103004856 |
| Provider Name | Jodi Tilley Province |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972638534 PECOS PAC ID: 5698928885 Enrollment ID: I20240111003553 |
| Provider Name | Beulah Gambill Coley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609391846 PECOS PAC ID: 1052763570 Enrollment ID: I20240122000029 |
| Provider Name | Kimberly Teala Pauline Pennell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952838831 PECOS PAC ID: 5193177541 Enrollment ID: I20240122001318 |
| Provider Name | Shean Kelly Harris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790223923 PECOS PAC ID: 0547604092 Enrollment ID: I20240223000005 |
| Provider Name | Deborah Suzanne Wages |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689138232 PECOS PAC ID: 6305282849 Enrollment ID: I20240307000349 |
Main St. Station Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 E Main St, Wilkesboro, NC 28697 Phone: 336-903-8500 Fax: 336-903-8505 | |
Children's Hope Alliance Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 507 Courthouse Dr, Wilkesboro, NC 28697 Phone: 336-667-3333 Fax: 336-667-8749 | |
Forest Hill Afl Home Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 323 Forest Hill Dr, Wilkesboro, NC 28697 Phone: 336-546-8702 | |
Old 60 Home Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 258 Old Highway 60, Wilkesboro, NC 28697 Phone: 404-364-2900 Fax: 404-364-2901 | |
Northwest Neurology, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1520 Meadowview Dr, Wilkesboro, NC 28697 Phone: 336-838-7111 Fax: 336-838-4299 | |
Turning Point Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1212 School St, Wilkesboro, NC 28697 Phone: 336-667-2408 |