Healthcare Provider Details

I. General information

NPI: 1780369215
Provider Name (Legal Business Name): JESSICA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 VINEHAVEN DR NE
CONCORD NC
28025-2439
US

IV. Provider business mailing address

1001 LITTLE JOHN TRL
KANNAPOLIS NC
28081-5762
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-1343
  • Fax:
Mailing address:
  • Phone: 980-250-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO19055
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: