Provider Demographics
NPI:1720768062
Name:FRENCH, JESSYCKA
Entity Type:Individual
Prefix:
First Name:JESSYCKA
Middle Name:
Last Name:FRENCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 STANTON DR APT 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-9045
Mailing Address - Country:US
Mailing Address - Phone:219-292-8006
Mailing Address - Fax:
Practice Address - Street 1:1117 E MOREHEAD ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2870
Practice Address - Country:US
Practice Address - Phone:980-220-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0194051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical