Provider Demographics
NPI:1083926018
Name:CALL, JESSICA BLACKBURN (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLACKBURN
Last Name:CALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1656
Mailing Address - Country:US
Mailing Address - Phone:336-838-1644
Mailing Address - Fax:336-667-7720
Practice Address - Street 1:204 JEFFERSON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3586
Practice Address - Country:US
Practice Address - Phone:336-838-1644
Practice Address - Fax:336-667-7720
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional