Provider Demographics
NPI:1932717378
Name:EPPERSON, JESSICA (MS, ALC, BC-TMH, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:MS, ALC, BC-TMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 LIBERTY PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7550
Mailing Address - Country:US
Mailing Address - Phone:816-550-4568
Mailing Address - Fax:
Practice Address - Street 1:3055 LORNA RD STE 200
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-4513
Practice Address - Country:US
Practice Address - Phone:205-202-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3545A101YM0800X, 101YP2500X
ALC3445A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty