MEDICARE: JESSICA LYNNE HUNTER LCSW

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	1041C0700X	Clinical Social Worker	P010136	NC

General Provider Information

NPI Number	:	1255854691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNNE HUNTER LCSW

Provider Business Mailing Address
First Line	:	3926 MIRIAM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7726
Country	:	US
Telephone Number	:	704-476-1580
Fax Number	:	704-251-0063

Provider Business Practice Location Address
First Line	:	3926 MIRIAM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7726
Country	:	US
Telephone Number	:	704-476-1580
Fax Number	:	704-251-0063

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

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	01/23/2024

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