Provider Demographics
NPI:1275821662
Name:PRESCOTT, JESSICA SANDERS (LCMHC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:SANDERS
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SANDERS
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 GOLDEN LEAF RD
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8216
Mailing Address - Country:US
Mailing Address - Phone:910-441-8759
Mailing Address - Fax:910-441-8759
Practice Address - Street 1:111 GOLDEN LEAF RD
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8216
Practice Address - Country:US
Practice Address - Phone:104-418-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12832101Y00000X, 101YM0800X
VT097.0078502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor