Provider Demographics
NPI:1225580459
Name:BECKMAN, JESSICA (LCMHC, LCAS, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:LCMHC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 CATHI LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9363
Mailing Address - Country:US
Mailing Address - Phone:336-496-8027
Mailing Address - Fax:
Practice Address - Street 1:1027 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7101
Practice Address - Country:US
Practice Address - Phone:336-496-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1692101YA0400X
NC7745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)