Provider Demographics
NPI:1972135457
Name:DILORENZO, JESSICA GRACE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:DILORENZO
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 1:3604 COURAGE CT SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2719
Mailing Address - Country:US
Mailing Address - Phone:704-425-6490
Mailing Address - Fax:
Practice Address - Street 1:3604 COURAGE CT SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2719
Practice Address - Country:US
Practice Address - Phone:704-425-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician