Provider Demographics
NPI:1316212335
Name:WHITE, JESSICA LYNNE (MSW, LCSW, RYT 200)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LCSW, RYT 200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214B N TOPSAIL DR
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6720
Mailing Address - Country:US
Mailing Address - Phone:703-477-3782
Mailing Address - Fax:
Practice Address - Street 1:214B N TOPSAIL DR
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-6720
Practice Address - Country:US
Practice Address - Phone:703-477-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0149191041C0700X
FLSW100731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical