Provider Demographics
NPI:1396939336
Name:COLE, JESSICA (LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:COLE
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 1:4 WATERSTONE PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5987
Mailing Address - Country:US
Mailing Address - Phone:601-906-5360
Mailing Address - Fax:
Practice Address - Street 1:1765 LELIA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4820
Practice Address - Country:US
Practice Address - Phone:601-906-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional