| Organization Name: | JODI PROVINCE COUNSELING SERVICES, PLLC |
| NPI Number: | 1194050435 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODI TILLEY PROVINCE (ORGANIZER/MEMBER) |
| Mailing Address: | 1260 College Ave Ste 1 Wilkesboro |
| State: | NC US |
| Postal Code: | 286972700 |
| Phone Number: | 3368180733 |
| Fax Number: | 3368180734 |
| NPI Enumeration Date: | 10/05/2009 |
| NPI Last Update Date: | 02/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 5534 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |