Provider Demographics
NPI:1366870768
Name:MCCLEESE, JESSICA (PSYD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCCLEESE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S INDEPENDENCE BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1150
Mailing Address - Country:US
Mailing Address - Phone:757-761-3334
Mailing Address - Fax:
Practice Address - Street 1:505 S INDEPENDENCE BLVD STE 213
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-347-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005219103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist