Provider Demographics
NPI:1780940130
Name:GODINO, JESSICA S (L AC)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:S
Last Name:GODINO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GROVE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3269
Mailing Address - Country:US
Mailing Address - Phone:828-350-5100
Mailing Address - Fax:
Practice Address - Street 1:43 GROVE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3269
Practice Address - Country:US
Practice Address - Phone:828-350-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist