Provider Demographics
NPI:1104378736
Name:WEBB, JESSICA YATES (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:YATES
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 TUTBURY DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7771
Mailing Address - Country:US
Mailing Address - Phone:336-404-5655
Mailing Address - Fax:
Practice Address - Street 1:4214 BEECHWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8131
Practice Address - Country:US
Practice Address - Phone:336-404-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0097871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical