Basic Information
| Provider Information | |||||||||
| NPI: | 1962520536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAWYER HORNE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | SYBIL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SAWYER | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | SYBIL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 S LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283793657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108952462 | ||||||||
| FaxNumber: | 9108959896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2421 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C006188 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6007037 | 05 | NC | MEDICAID |