Provider Demographics
NPI:1720887730
Name:MEDLIN, JAIDEN (LCSW-A)
Entity type:Individual
Prefix:
First Name:JAIDEN
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SCOTTS STORE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-5908
Mailing Address - Country:US
Mailing Address - Phone:910-298-1098
Mailing Address - Fax:
Practice Address - Street 1:441 SCOTTS STORE RD
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-5908
Practice Address - Country:US
Practice Address - Phone:910-298-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3382051041S0200X
NCP0216341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool