Provider Demographics
NPI:1982368668
Name:MCINTYRE, JESSICA MICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHOLE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ASHEBERNE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-6630
Mailing Address - Country:US
Mailing Address - Phone:252-814-0468
Mailing Address - Fax:
Practice Address - Street 1:117 ASHEBERNE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-6630
Practice Address - Country:US
Practice Address - Phone:252-814-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0137771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical