Provider Demographics
NPI:1598158024
Name:TRUMP, JESSICA (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TRUMP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:SUITE 125
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3065
Mailing Address - Country:US
Mailing Address - Phone:540-272-9230
Mailing Address - Fax:
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 125
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3065
Practice Address - Country:US
Practice Address - Phone:540-272-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health