Provider Demographics
NPI:1023441458
Name:AYCOCK, JAMILLE
Entity type:Individual
Prefix:MS
First Name:JAMILLE
Middle Name:
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 JOE SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-8630
Mailing Address - Country:US
Mailing Address - Phone:919-344-3009
Mailing Address - Fax:
Practice Address - Street 1:114 JOE SUTTON RD
Practice Address - Street 2:
Practice Address - City:FAISON
Practice Address - State:NC
Practice Address - Zip Code:28341-8630
Practice Address - Country:US
Practice Address - Phone:919-344-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst