Provider Demographics
NPI:1215513726
Name:WINN, JESSICA (MA, LPCA, ADC-IP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WINN
Suffix:
Gender:F
Credentials:MA, LPCA, ADC-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 KENNESTONE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-6841
Mailing Address - Country:US
Mailing Address - Phone:843-607-6627
Mailing Address - Fax:
Practice Address - Street 1:8523 KENNESTONE LN
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-6841
Practice Address - Country:US
Practice Address - Phone:843-607-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health