| Doctor Name: | MISS ERICA OWEN JERNIGAN |
| NPI Number: | 1508059445 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | 4132 |
| Business Practice Address: | 305 N State St Yadkinville, NC - 270555245 |
| Business Phone Number: | 3366798921 |
| Business Fax Number: | |
| Mailing Address: | 430 S Cliffdale Dr, WINSTON SALEM |
| State: | NC |
| Postal Code: | 271043808 |
| Phone Number: | 3366597784 |
| Fax Number: | 3366792909 |
| NPI Enumeration Date: | 08/23/2007 |
| NPI Last Update Date: | 08/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | 4132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |