Provider Demographics
NPI:1184737124
Name:FRATRIK, JESSICA D (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:FRATRIK
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 1:2215 LANGHORNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:434-948-4918
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-948-3810
Practice Address - Fax:434-948-4918
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical