Provider Demographics
NPI:1518500354
Name:RUBALCABA, JESSICA (LPCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RUBALCABA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6064
Mailing Address - Country:US
Mailing Address - Phone:704-910-5810
Mailing Address - Fax:980-207-0214
Practice Address - Street 1:5203 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4721
Practice Address - Country:US
Practice Address - Phone:704-554-9900
Practice Address - Fax:704-554-9956
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional