NPIMap

Organization Active NPI

Jodi Province Counseling Services PLLC

  • Mental Health Counselor
  • Wilkesboro, NC
National Provider Identifier
1194050435
Registry record updated May 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JODI PROVINCE COUNSELING SERVICES PLLC
Practice address
1260 College Ave Ste 1
Wilkesboro, NC 28697-2700
Phone
(336) 818-0733
Fax
(336) 818-0734
NPI assigned
Oct 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jodi Tilley Province, MA, LPC, NCCNPI 1972638534
Title
Organizer/Member
Phone
(336) 818-0733

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1260 College Ave Ste 1
Wilkesboro, NC 28697-2700

Mailing address

1260 College Ave Ste 1
Wilkesboro, NC 28697-2700
Phone (336) 818-0733

Other practice location 1

314 Winston Rd
Jonesville, NC 28642-2214
Phone (336) 818-0733

Other practice location 2

934 Nc Highway 88 W
Jefferson, NC 28640-8813
Phone (336) 818-0733

Other practice location 3

2587 Pleasant Ridge Rd
State Road, NC 28676-9318
Phone (336) 818-0733 ext. 201

Other practice location 4

714 Carolina Ave Ste A
Yadkinville, NC 27055-7793
Phone (336) 818-0733 ext. 101

Other practice location 5

50 Lucy Echerd Ln
Taylorsville, NC 28681-3099
Phone (336) 818-0733

Other practice location 6

301 S Church St Ste 293
Rocky Mount, NC 27804-5753
Phone (336) 818-0733

Other identifiers 9

IdentifierTypeStateIssuer
6103527MedicaidNC
6112147MedicaidNC
6102745MedicaidNC
6112237MedicaidNC
6106369MedicaidNC
6103333MedicaidNC
6105186MedicaidNC
144VWOtherNCBCBSNC
6107594MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121228000228 NC Part B Supplier - Clinic/Group Practice 3678726569 Receives reassigned benefits from 20 practitioners
Practice locations: Jefferson, NC; Yadkinville, NC; Wilkesboro, NC; Rocky Mount, NC; Jonesville, NC; Taylorsville, NC

National Provider Directory

National Provider Directory
Tax ID family
Jodi Province Counseling Services PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

314 Winston Rd
Jonesville, NC 28642
Phone 3368180733 ext. 203

146 Woodridge Ct
Rocky Mount, NC 27804

301 S Church St
Ste 293
Rocky Mount, NC 27804

2587 Pleasant Ridge Rd
State Road, NC 28676
Phone 3368180733 ext. 201

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779408000000",
    "number": "1194050435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 COLLEGE AVE STE 1",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286972700",
            "telephone_number": "336-818-0733",
            "fax_number": "336-818-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 COLLEGE AVE STE 1",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286972700",
            "telephone_number": "336-818-0733",
            "fax_number": "336-818-0734"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 Winston Rd",
            "address_purpose": "LOCATION",
            "city": "Jonesville",
            "state": "NC",
            "postal_code": "286422214",
            "country_code": "US",
            "telephone_number": "336-818-0733",
            "fax_number": "336-818-0734",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "934 Nc Highway 88 W",
            "address_purpose": "LOCATION",
            "city": "Jefferson",
            "state": "NC",
            "postal_code": "286408813",
            "country_code": "US",
            "telephone_number": "336-818-0733",
            "fax_number": "336-818-0734",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2587 Pleasant Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "State Road",
            "state": "NC",
            "postal_code": "286769318",
            "country_code": "US",
            "telephone_number": "336-818-0733 x201",
            "fax_number": "336-571-1012",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "714 Carolina Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Yadkinville",
            "state": "NC",
            "postal_code": "270557793",
            "country_code": "US",
            "telephone_number": "336-818-0733 x101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 Lucy Echerd Ln",
            "address_purpose": "LOCATION",
            "city": "Taylorsville",
            "state": "NC",
            "postal_code": "286813099",
            "country_code": "US",
            "telephone_number": "336-818-0733",
            "fax_number": "336-818-0734",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 S Church St Ste 293",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278045753",
            "country_code": "US",
            "telephone_number": "336-818-0733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JODI PROVINCE COUNSELING SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-05",
        "last_updated": "2026-05-22",
        "certification_date": "2026-05-22",
        "status": "A",
        "authorized_official_last_name": "PROVINCE",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "TILLEY",
        "authorized_official_title_or_position": "ORGANIZER/MEMBER",
        "authorized_official_telephone_number": "336-818-0733",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103527",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112147",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102745",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112237",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106369",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103333",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6105186",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "144VW",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107594",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.