Provider Demographics
NPI:1750793006
Name:GAGE, JESSICA MARIE (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:GAGE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 UNION AVE
Mailing Address - Street 2:4TH FLOOR: CCC
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5523
Mailing Address - Country:US
Mailing Address - Phone:724-207-3767
Mailing Address - Fax:
Practice Address - Street 1:801 UNION AVE
Practice Address - Street 2:4TH FLOOR: CCC
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5523
Practice Address - Country:US
Practice Address - Phone:724-207-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional