Provider Demographics
NPI:1457096315
Name:LANDS, JESSICA RENEE (LPA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:LANDS
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 DURHAM CHAPEL HILL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2877
Mailing Address - Country:US
Mailing Address - Phone:919-402-8738
Mailing Address - Fax:
Practice Address - Street 1:2634 DURHAM CHAPEL HILL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2877
Practice Address - Country:US
Practice Address - Phone:919-402-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6085103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist