Provider Demographics
NPI:1982376042
Name:CLEM, JESSICA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CLEM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BLOOMSBERRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7291
Mailing Address - Country:US
Mailing Address - Phone:919-592-8848
Mailing Address - Fax:
Practice Address - Street 1:1250 SE MAYNARD RD STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6947
Practice Address - Country:US
Practice Address - Phone:919-948-7718
Practice Address - Fax:919-300-7943
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO118181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical