Provider Demographics
NPI:1568727568
Name:ESCOBAR LOPEZ, JESSICA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ESCOBAR LOPEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KELLY PL
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2609
Mailing Address - Country:US
Mailing Address - Phone:336-812-9733
Mailing Address - Fax:
Practice Address - Street 1:204 KELLY PL
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2609
Practice Address - Country:US
Practice Address - Phone:336-812-9733
Practice Address - Fax:336-812-9374
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27782101YM0800X
NCC0120281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health