1275889685 NPI number — MRS. JESSICA KYLIE MORMAN MA, LMFT

Table of content: MRS. JESSICA KYLIE MORMAN MA, LMFT (NPI 1275889685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275889685 NPI number — MRS. JESSICA KYLIE MORMAN MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORMAN
Provider First Name:
JESSICA
Provider Middle Name:
KYLIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
KYLIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275889685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 GILES AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-599-1169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 GILES AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-467-8688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1513 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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