Provider Demographics
NPI:1245685569
Name:MOORE, JESALYN (LCSW, LSATP, CAADC)
Entity type:Individual
Prefix:
First Name:JESALYN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW, LSATP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 JOHN ROLFE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-1412
Mailing Address - Country:US
Mailing Address - Phone:757-508-2649
Mailing Address - Fax:
Practice Address - Street 1:138 JOHN ROLFE LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-1412
Practice Address - Country:US
Practice Address - Phone:757-508-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical