Provider Demographics
NPI:1104121342
Name:HOLSTON, JESSECA LEE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JESSECA
Middle Name:LEE
Last Name:HOLSTON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CASSIDY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5314
Mailing Address - Country:US
Mailing Address - Phone:760-721-2171
Mailing Address - Fax:760-721-8582
Practice Address - Street 1:2501 ALLEGHANY LOOP
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2442
Practice Address - Country:US
Practice Address - Phone:858-349-0873
Practice Address - Fax:858-349-0873
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001507106H00000X
CA95098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist