Provider Demographics
NPI:1770030629
Name:HOUSTON, JESSICA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 GRAND SUMMIT BLVD
Mailing Address - Street 2:APT 7119
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3638
Mailing Address - Country:US
Mailing Address - Phone:919-215-1293
Mailing Address - Fax:
Practice Address - Street 1:919 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2355
Practice Address - Country:US
Practice Address - Phone:704-660-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0108261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical