Provider Demographics
NPI:1871850495
Name:JEREMIAH, JESSICA (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JEREMIAH
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EAST CENTER STREET
Mailing Address - Street 2:SUITE B-11
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9725
Mailing Address - Country:US
Mailing Address - Phone:919-239-5133
Mailing Address - Fax:704-972-9749
Practice Address - Street 1:105 EAST CENTER STREET
Practice Address - Street 2:SUITE B-11
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9725
Practice Address - Country:US
Practice Address - Phone:919-239-5133
Practice Address - Fax:704-972-9749
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0088401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical