Basic Information
| Provider Information | |||||||||
| NPI: | 1740798842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILLY | ||||||||
| FirstName: | JAMETTA | ||||||||
| MiddleName: | KARIE | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 CHEYENNE DR APT L | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274106507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047701996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 284 EXECUTIVE PARK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A13543 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | A13543 | NC | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.