Healthcare Provider Details

I. General information

NPI: 1629397740
Provider Name (Legal Business Name): JESSICA PSUJEK WAKEFIELD LCMHC, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 STANTONSBURG RD
GREENVILLE NC
27834-2800
US

IV. Provider business mailing address

1919 CHERRY STONE LN
GREENVILLE NC
27858-9415
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-9477
  • Fax: 252-847-0819
Mailing address:
  • Phone: 919-475-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7297
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: