Provider Demographics
NPI:1164003471
Name:COLE, JESSICA FANCHER (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FANCHER
Last Name:COLE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BETTS WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-0683
Mailing Address - Country:US
Mailing Address - Phone:304-629-0900
Mailing Address - Fax:
Practice Address - Street 1:270 BETTS WAY
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-0683
Practice Address - Country:US
Practice Address - Phone:304-629-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009444441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical