Jenny F Wagstaff, PHD, LPC-S, NCC, ACS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S13702 Issued in NC

Practice address

817 W Front St
Lillington, NC 27546-9735

Phone

(910) 814-2197

Fax

(910) 814-2167

NPI assigned

Jul 10, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peace of Mind, Inc.

  • Professional Counselor
  • Lillington, NC
  • NPI 1417144106
  NPD (past)

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1386130524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "BUIES CREEK",
            "state": "NC",
            "postal_code": "275060369",
            "telephone_number": "910-893-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W FRONT ST",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275469735",
            "telephone_number": "910-814-2197",
            "fax_number": "910-814-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "JENNY",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC-S, NCC, ACS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701005095",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "S13702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacques Maurice Villien, DO
• Madhuri V Vithala, MD
• Elizabeth Voegtlin
• Haley Gower Vradenburgh, CCC- SLP
• Alison Lee Vurnakes, MD
• Shauna Waldon
• Nia Walker
• Robert Waiyaki Wanjiru
• Deborah Jackson Warren, RN,FNP
• Kayla Lynne Watts

• Mental Health Counselor in Lillington, NC
• Providers in Lillington, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.