Provider Demographics
NPI:1699129593
Name:GADA, JESSICA H (LCPAT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:H
Last Name:GADA
Suffix:
Gender:F
Credentials:LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 43RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2007
Mailing Address - Country:US
Mailing Address - Phone:401-338-7807
Mailing Address - Fax:
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 408
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:240-630-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health