Basic Information
| Provider Information | |||||||||
| NPI: | 1003374802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JILLIAN MARTINDALE, LCSW, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 HUNTER ST | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287147137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282634467 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287142925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282634467 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | MARTINDALE | ||||||||
| AuthorizedOfficialFirstName: | JILLIAN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8282634467 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.