Provider Demographics
NPI:1669056131
Name:CANTEEN, JESSICA CHARISE (MED, MHC, LPC, CEP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CHARISE
Last Name:CANTEEN
Suffix:
Gender:F
Credentials:MED, MHC, LPC, CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 FLOYD RD SW UNIT 767
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6107
Mailing Address - Country:US
Mailing Address - Phone:678-460-6334
Mailing Address - Fax:
Practice Address - Street 1:5284 FLOYD RD SW UNIT 767
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-6107
Practice Address - Country:US
Practice Address - Phone:678-460-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00880500101YP2500X
WALH61356267101YP2500X
PAPC014914101YP2500X
GALPC012698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional