Provider Demographics
NPI:1477942720
Name:MIDDLETON, JESSICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 LEESBURG LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7644
Mailing Address - Country:US
Mailing Address - Phone:919-673-2415
Mailing Address - Fax:
Practice Address - Street 1:5317 HIGHGATE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6622
Practice Address - Country:US
Practice Address - Phone:919-673-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional