Provider Demographics
NPI:1750875845
Name:BLOCK, JESSICA LYNN (MA, NCC, LPCA, LCASA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MA, NCC, LPCA, LCASA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LPCA, LCASA
Mailing Address - Street 1:6905 RIVER RUN APT 26
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-2209
Mailing Address - Country:US
Mailing Address - Phone:919-271-2013
Mailing Address - Fax:
Practice Address - Street 1:1135 KILDAIRE FARM RD STE 303
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4587
Practice Address - Country:US
Practice Address - Phone:919-678-3817
Practice Address - Fax:919-747-4257
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC830000101Y00000X
NC23992101YA0400X
NCA13591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)