Provider Demographics
NPI:1710762935
Name:SOUZA, JESSICA ARON
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARON
Last Name:SOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 LAMOND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2074
Mailing Address - Country:US
Mailing Address - Phone:919-587-8018
Mailing Address - Fax:
Practice Address - Street 1:1006 LAMOND AVE STE A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2074
Practice Address - Country:US
Practice Address - Phone:919-587-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health