Provider Demographics
NPI:1649424862
Name:HENKEL, JESSICA C (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:HENKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28126-0568
Mailing Address - Country:US
Mailing Address - Phone:704-547-1483
Mailing Address - Fax:704-547-0052
Practice Address - Street 1:10001 OLD CONCORD ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3646
Practice Address - Country:US
Practice Address - Phone:704-547-1483
Practice Address - Fax:704-547-0052
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007194Medicaid