Provider Demographics
NPI:1275278095
Name:CRATCH, JESSICA DANIELLE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:CRATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 KINGSFORD DR # 31
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-4128
Mailing Address - Country:US
Mailing Address - Phone:336-486-3679
Mailing Address - Fax:
Practice Address - Street 1:2324 CONCORD LAKE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2814
Practice Address - Country:US
Practice Address - Phone:704-935-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional