Provider Demographics
NPI:1215693247
Name:TROUTMAN, JESSICA LEIGH (LCSWA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LIVINGSTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4400
Mailing Address - Country:US
Mailing Address - Phone:828-707-4473
Mailing Address - Fax:828-236-9825
Practice Address - Street 1:209 BARIUM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-8454
Practice Address - Country:US
Practice Address - Phone:704-832-2200
Practice Address - Fax:704-838-1541
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP017096104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP017096OtherLICENSE