Provider Demographics
NPI:1144879693
Name:DILWORTH, JESSICA (MSW, QMHP A/C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:MSW, QMHP A/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 KING ST APT 403
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3547
Mailing Address - Country:US
Mailing Address - Phone:510-576-9695
Mailing Address - Fax:
Practice Address - Street 1:517 KING ST APT 403
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3547
Practice Address - Country:US
Practice Address - Phone:510-576-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2025-04-07
Deactivation Date:2023-10-12
Deactivation Code:
Reactivation Date:2023-11-02
Provider Licenses
StateLicense IDTaxonomies
VA09060129651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical