MEDICARE: JELISSA CHRISTINA DEESE MS, LCMHCA, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A22603	NC

General Provider Information

NPI Number	:	1144175811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JELISSA CHRISTINA DEESE MS, LCMHCA, NCC

Provider Business Mailing Address
First Line	:	4222 POPLAR GROVE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0433
Country	:	US
Telephone Number	:	704-608-8234
Fax Number	:

Provider Business Practice Location Address
First Line	:	4222 POPLAR GROVE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0433
Country	:	US
Telephone Number	:	704-608-8234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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