Provider Demographics
NPI:1649750571
Name:MCDONALD, JESSICA LYNELL (LPC-A)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNELL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5866
Mailing Address - Country:US
Mailing Address - Phone:919-633-5953
Mailing Address - Fax:
Practice Address - Street 1:44 DREAM AVE
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8700
Practice Address - Country:US
Practice Address - Phone:910-655-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health