Healthcare Provider Details

I. General information

NPI: 1235802554
Provider Name (Legal Business Name): JESSICA NICOLE MCALLISTER LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA HARPER

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HAY ST
FAYETTEVILLE NC
28305-5312
US

IV. Provider business mailing address

2919 BREEZEWOOD AVE STE 101
FAYETTEVILLE NC
28303-5283
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-7008
  • Fax: 910-824-7593
Mailing address:
  • Phone: 910-484-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020999
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number11952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: