Provider Demographics
NPI:1306225552
Name:ESCOBAR, JESSICA (MS)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10340 DEMOCRACY LN STE 104
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2518
Mailing Address - Country:US
Mailing Address - Phone:703-672-0043
Mailing Address - Fax:
Practice Address - Street 1:10340 DEMOCRACY LN STE 104
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2518
Practice Address - Country:US
Practice Address - Phone:703-672-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist