Provider Demographics
NPI:1356660419
Name:FRIPP, JESSICA ANTOINETTE (MED)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANTOINETTE
Last Name:FRIPP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 OAKCREST GREEN DRIVE
Mailing Address - Street 2:APT. 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4300
Mailing Address - Country:US
Mailing Address - Phone:704-262-1320
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N
Practice Address - Street 2:SUITE 305
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4300
Practice Address - Country:US
Practice Address - Phone:704-262-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health