Provider Demographics
NPI:1134502123
Name:WHITE, JESSICA (LISW,LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LISW,LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:TUCKER LISW,LICSW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TUCKER
Mailing Address - Street 1:402 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2124
Mailing Address - Country:US
Mailing Address - Phone:740-629-4300
Mailing Address - Fax:
Practice Address - Street 1:402 FRONT ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2124
Practice Address - Country:US
Practice Address - Phone:740-629-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2102687104100000X, 1041C0700X
WVAP00944679104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker