Provider Demographics
NPI:1528496072
Name:NEWTON, JESSICA (LCAS, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2071
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-2071
Mailing Address - Country:US
Mailing Address - Phone:919-269-9300
Mailing Address - Fax:877-698-8894
Practice Address - Street 1:3904 AIRPORT DR NW STE A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8040
Practice Address - Country:US
Practice Address - Phone:919-269-9300
Practice Address - Fax:877-698-8894
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3524101YA0400X
NC10479101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health