MEDICARE: JESSICA MONIQUE HERRING

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1164239539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MONIQUE HERRING

Provider Business Mailing Address
First Line	:	6416 CARMEL RD STE 400B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 CARMEL RD STE 400B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8268
Country	:	US
Telephone Number	:	603-606-1233
Fax Number	:

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

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	01/04/2025

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