Provider Demographics
NPI:1780370726
Name:CARROLL, JESSICA (LPC-R)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 N ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4887
Mailing Address - Country:US
Mailing Address - Phone:540-222-5117
Mailing Address - Fax:
Practice Address - Street 1:2201 CHARLES ST STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3378
Practice Address - Country:US
Practice Address - Phone:540-845-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health