Provider Demographics
NPI:1134830946
Name:WHEATON, JESSICA (MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHEATON
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:DOROTHY
Mailing Address - State:NJ
Mailing Address - Zip Code:08317-0151
Mailing Address - Country:US
Mailing Address - Phone:609-602-9822
Mailing Address - Fax:
Practice Address - Street 1:900 ROUTE 168 STE G3
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3235
Practice Address - Country:US
Practice Address - Phone:856-302-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00404500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor