Provider Demographics
NPI:1629404827
Name:BRICKEY, JESSICA CANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CANN
Last Name:BRICKEY
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 1:7905 WADDILL DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3828
Mailing Address - Country:US
Mailing Address - Phone:804-200-3701
Mailing Address - Fax:
Practice Address - Street 1:1617 MONUMENT AVE STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-2943
Practice Address - Country:US
Practice Address - Phone:804-322-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical