Provider Demographics
NPI:1255854691
Name:HUNTER, JESSICA LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:HUNTER
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 1:3926 MIRIAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7726
Mailing Address - Country:US
Mailing Address - Phone:704-476-1580
Mailing Address - Fax:704-251-0063
Practice Address - Street 1:3926 MIRIAM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7726
Practice Address - Country:US
Practice Address - Phone:704-476-1580
Practice Address - Fax:704-251-0063
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0101361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical