Provider Demographics
NPI:1013601723
Name:HENNING, JESSICA LEE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:HENNING
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CROWN CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7804
Mailing Address - Country:US
Mailing Address - Phone:704-849-0144
Mailing Address - Fax:
Practice Address - Street 1:2124 CROWN CENTRE DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7804
Practice Address - Country:US
Practice Address - Phone:704-849-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health