Provider Demographics
NPI:1013447960
Name:CHERRY, JALESSA SHANICE (LCSW)
Entity type:Individual
Prefix:
First Name:JALESSA
Middle Name:SHANICE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 ARBOR GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2267
Mailing Address - Country:US
Mailing Address - Phone:252-259-7030
Mailing Address - Fax:
Practice Address - Street 1:123 PROFESSIONAL PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5516
Practice Address - Country:US
Practice Address - Phone:704-749-9560
Practice Address - Fax:833-918-2112
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0115991041C0700X
NCC0127261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical