Healthcare Provider Details

I. General information

NPI: 1053132720
Provider Name (Legal Business Name): JESSIE KNOWLES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JESSIE REBECCA KNOWLES

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLADENSBURG RD NE STE 101
WASHINGTON DC
20002-8971
US

IV. Provider business mailing address

2105 N GLEBE RD UNIT 1224
ARLINGTON VA
22207-2231
US

V. Phone/Fax

Practice location:
  • Phone: 757-784-6031
  • Fax:
Mailing address:
  • Phone: 757-784-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003822
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: