Provider Demographics
NPI:1801450465
Name:WALTERS HOUSTON, JESSICA CAROL (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CAROL
Last Name:WALTERS HOUSTON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CAROL
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:136 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1244
Mailing Address - Country:US
Mailing Address - Phone:757-449-7600
Mailing Address - Fax:
Practice Address - Street 1:17579 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23603-1343
Practice Address - Country:US
Practice Address - Phone:757-888-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health