Provider Demographics
NPI:1710452727
Name:WINEBARGER, JESSICA BLAIR (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIR
Last Name:WINEBARGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BLAIR
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 J N PEASE PL STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4542
Mailing Address - Country:US
Mailing Address - Phone:704-729-4979
Mailing Address - Fax:
Practice Address - Street 1:1935 J N PEASE PL STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4542
Practice Address - Country:US
Practice Address - Phone:980-272-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health