Provider Demographics
NPI:1639691132
Name:AUSLANDER, JESSICA LEVY (LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEVY
Last Name:AUSLANDER
Suffix:
Gender:F
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7179
Mailing Address - Country:US
Mailing Address - Phone:1614-560-3905
Mailing Address - Fax:
Practice Address - Street 1:3820 LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7179
Practice Address - Country:US
Practice Address - Phone:704-277-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13016101Y00000X
OHC1200554101Y00000X
NCLCAS-23545101YA0400X
OH141070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)