Provider Demographics
NPI:1831653807
Name:MCDONALD, JESSICA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 DALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1507
Mailing Address - Country:US
Mailing Address - Phone:251-767-0163
Mailing Address - Fax:
Practice Address - Street 1:4087 COTTAGE HILL RD STE B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4226
Practice Address - Country:US
Practice Address - Phone:251-616-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional