Provider Demographics
NPI:1619224888
Name:MCFADDEN, JESLYN THAXTON (LPC, NCC, MA)
Entity Type:Individual
Prefix:MRS
First Name:JESLYN
Middle Name:THAXTON
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LPC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7821
Mailing Address - Country:US
Mailing Address - Phone:704-372-4010
Mailing Address - Fax:704-536-3508
Practice Address - Street 1:4919 MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7821
Practice Address - Country:US
Practice Address - Phone:704-372-4010
Practice Address - Fax:704-536-3508
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional