Provider Demographics
NPI:1043457062
Name:SOULE, JESSICA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SOULE
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 1:9003 WESTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2201
Mailing Address - Country:US
Mailing Address - Phone:919-459-1635
Mailing Address - Fax:919-677-1489
Practice Address - Street 1:9003 WESTON PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2201
Practice Address - Country:US
Practice Address - Phone:919-459-1635
Practice Address - Fax:919-677-1489
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0062501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical