Provider Demographics
NPI:1013492040
Name:VANDEVELDE, JESSICA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VANDEVELDE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12281 WOODRUN DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-2055
Mailing Address - Country:US
Mailing Address - Phone:586-419-2608
Mailing Address - Fax:
Practice Address - Street 1:15 DAWN RD # 2
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9123
Practice Address - Country:US
Practice Address - Phone:910-585-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
NCP0189261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool