Healthcare Provider Details

I. General information

NPI: 1639540255
Provider Name (Legal Business Name): JENNY ESCUE LPCA, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 COX RD
GASTONIA NC
28054-0628
US

IV. Provider business mailing address

515 CLANTON RD
CHARLOTTE NC
28217-1309
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1558
  • Fax: 704-865-9908
Mailing address:
  • Phone: 704-332-9001
  • Fax: 704-295-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA11808
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11808
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: