Provider Demographics
NPI:1598306789
Name:EDDINS, JESSICA RENEE (LPC, RPRS, CSAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:EDDINS
Suffix:
Gender:F
Credentials:LPC, RPRS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 MARIO CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1543
Mailing Address - Country:US
Mailing Address - Phone:757-266-9450
Mailing Address - Fax:
Practice Address - Street 1:1545 CROSSWAYS BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0205
Practice Address - Country:US
Practice Address - Phone:757-606-0086
Practice Address - Fax:757-299-8382
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103373101YA0400X
VA0701010121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)