Provider Demographics
NPI:1881196673
Name:GLYNN, JESSICA L
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:GLYNN
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT-A
Mailing Address - Street 1:3019 RED BARK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-1313
Mailing Address - Country:US
Mailing Address - Phone:631-513-5712
Mailing Address - Fax:
Practice Address - Street 1:3019 RED BARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-1313
Practice Address - Country:US
Practice Address - Phone:631-513-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor