Provider Demographics
NPI:1679243034
Name:THOMAS, JESSICA AUSTIN (MA, EDS, LMHP-R)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:AUSTIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, EDS, LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 DEBACA CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6601
Mailing Address - Country:US
Mailing Address - Phone:757-619-5852
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE BLVD STE 532
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5473
Practice Address - Country:US
Practice Address - Phone:757-962-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health