Provider Demographics
NPI:1386761328
Name:KESSINGER, JESSE A (LGPC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:KESSINGER
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2663
Mailing Address - Country:US
Mailing Address - Phone:410-707-2679
Mailing Address - Fax:
Practice Address - Street 1:4833 RUGBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3035
Practice Address - Country:US
Practice Address - Phone:443-774-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD615501400Medicaid