Provider Demographics
NPI:1508597881
Name:CYRUS, JESSICA ANIL (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANIL
Last Name:CYRUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 POINDEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2025
Mailing Address - Country:US
Mailing Address - Phone:336-995-9329
Mailing Address - Fax:
Practice Address - Street 1:3918 POINDEXTER AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2025
Practice Address - Country:US
Practice Address - Phone:336-995-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC014346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker