Provider Demographics
NPI:1447773981
Name:WOODARD PYBURN, JADE (LCSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:WOODARD PYBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TRUE VINE RD NE
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-8225
Mailing Address - Country:US
Mailing Address - Phone:919-222-2625
Mailing Address - Fax:
Practice Address - Street 1:2401 WOOTEN BLVD SW STE K
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4464
Practice Address - Country:US
Practice Address - Phone:770-527-7966
Practice Address - Fax:252-291-2890
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0114381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical