Ricketson, Jake Edwin

Ricketson, Jake Edwin is an sole proprietor health care provider with primary practice located at 405 Westwood Ave , High Point NC 27262-4325. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ricketson, Jake Edwin can be contacted via phone (336) 887-7350.

Contact Information

Primary practice address
405 Westwood Ave High Point NC 27262-4325
Phone: (336) 887-7350
Fax: (336) 887-7353
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1167 North Carolina

Profile Details

NPI number 1356409734
LBN Legal business name Ricketson, Jake Edwin
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 5th, 2006
Last updated Feb 9th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356409734 NPPES
North Carolina Other 04492 BCBS PRIVATE INSURANCE
North Carolina MEDICAID 6000026 BCBS PRIVATE INSURANCE
North Carolina Other 21519 BCBS PRIVATE INSURANCE

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