Provider Demographics
NPI:1396488300
Name:JESSEE, MARY CATHERINE ALDERSON (LPC)
Entity type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:ALDERSON
Last Name:JESSEE
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 1:403 STOCKTON ST APT 4214
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4364
Mailing Address - Country:US
Mailing Address - Phone:804-887-9555
Mailing Address - Fax:
Practice Address - Street 1:6010 W BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2215
Practice Address - Country:US
Practice Address - Phone:804-282-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health