Provider Demographics
NPI:1376289629
Name:MANDELL, JESSICA EDEN (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EDEN
Last Name:MANDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MOCKINGBIRD LN STE 580
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1171
Mailing Address - Country:US
Mailing Address - Phone:704-910-8381
Mailing Address - Fax:704-981-8282
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 580
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1171
Practice Address - Country:US
Practice Address - Phone:704-910-8381
Practice Address - Fax:704-981-8282
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist