Basic Information
| Provider Information | |||||||||
| NPI: | 1902352099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINDALE | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | KRUPP | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 HUNTER ST | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287147137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282634467 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 669 S HAYWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287866703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286313973 | ||||||||
| FaxNumber: | 8286319280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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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 | 1041C0700X | P010578 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C011825 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.