Provider Demographics
NPI:1780089466
Name:JESSUP, SYLVIA DIANE (LPCA, LMFTA)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:DIANE
Last Name:JESSUP
Suffix:
Gender:F
Credentials:LPCA, LMFTA
Other - Prefix:MRS
Other - First Name:SYLVIA
Other - Middle Name:DIANE
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13016 EASTFIELD RD
Mailing Address - Street 2:SUITE 200-217
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6622
Mailing Address - Country:US
Mailing Address - Phone:701-572-1188
Mailing Address - Fax:704-948-6254
Practice Address - Street 1:5437 MCCHESNEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7187
Practice Address - Country:US
Practice Address - Phone:704-572-1188
Practice Address - Fax:704-948-6254
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10031A101YP2500X
NC10020A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist