Provider Demographics
NPI:1164824843
Name:CROWE, JESSICA NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOLE
Last Name:CROWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5332
Mailing Address - Country:US
Mailing Address - Phone:828-273-8108
Mailing Address - Fax:704-582-6207
Practice Address - Street 1:9541 JULIAN CLARK AVE STE 106B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3485
Practice Address - Country:US
Practice Address - Phone:828-273-8108
Practice Address - Fax:704-582-6207
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0089851041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164824843Medicaid