Provider Demographics
NPI:1306268669
Name:SCALES, JESSICA (LPCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S VAN BUREN RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5083
Mailing Address - Country:US
Mailing Address - Phone:336-627-5437
Mailing Address - Fax:336-627-1681
Practice Address - Street 1:509 S VAN BUREN RD STE B
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5083
Practice Address - Country:US
Practice Address - Phone:336-627-5437
Practice Address - Fax:336-627-1681
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10501101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional