Provider Demographics
NPI:1427034800
Name:POWELL, JESSICA (LPA LPC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4086
Mailing Address - Country:US
Mailing Address - Phone:910-791-5575
Mailing Address - Fax:910-799-5576
Practice Address - Street 1:1133 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3684
Practice Address - Country:US
Practice Address - Phone:910-791-5575
Practice Address - Fax:910-799-5576
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4808101YP2500X
NC2411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344161OtherTRICARE
NC6107095Medicaid
NC1408COtherBLUE CROSS BLUE SHIED