Active NPI
Jacqueline Wood Mardis, LPC
- Professional Counselor
- Fayetteville, NC
National Provider Identifier
1750676466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2939
- Practice address
- 6855 Bryanstone Way
Fayetteville, NC 28314-5313 - Phone
- (910) 868-5266
- NPI assigned
- Jun 10, 2011
- Last updated
- Jun 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2939 | NC | Primary |
Addresses
Primary practice location
6855 Bryanstone Way
Fayetteville, NC 28314-5313
Mailing address
6855 Bryanstone Way
Fayetteville, NC 28314-5313
Phone (910) 868-5266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2939 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307664000000",
"number": "1750676466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6855 BRYANSTONE WAY",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283145313",
"telephone_number": "910-868-5266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6855 BRYANSTONE WAY",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283145313",
"telephone_number": "910-868-5266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDIS",
"first_name": "JACQUELINE",
"middle_name": "WOOD",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-10",
"last_updated": "2011-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.