Provider Demographics
NPI:1962775635
Name:LAUBE, JESSICA C (MSW, P-LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:LAUBE
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S MAIN ST
Mailing Address - Street 2:A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5756
Mailing Address - Country:US
Mailing Address - Phone:336-437-4991
Mailing Address - Fax:336-229-5906
Practice Address - Street 1:909 S MAIN ST
Practice Address - Street 2:A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5756
Practice Address - Country:US
Practice Address - Phone:336-437-4991
Practice Address - Fax:336-229-5906
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0064931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical