Provider Demographics
NPI:1275889685
Name:MORMAN, JESSICA KYLIE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KYLIE
Last Name:MORMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:KYLIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 GILES AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4759
Mailing Address - Country:US
Mailing Address - Phone:910-599-1169
Mailing Address - Fax:
Practice Address - Street 1:108 GILES AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4759
Practice Address - Country:US
Practice Address - Phone:910-467-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist