Provider Demographics
NPI:1245890904
Name:SIBOLD, JESSICA LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SIBOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 ELK HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-3318
Mailing Address - Country:US
Mailing Address - Phone:540-421-0992
Mailing Address - Fax:
Practice Address - Street 1:1975 ELK HILL RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3318
Practice Address - Country:US
Practice Address - Phone:540-421-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional