Healthcare Provider Details

I. General information

NPI: 1902442791
Provider Name (Legal Business Name): JESSICA LYNN NOWADLY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5692 SILER ST
TRINITY NC
27370-8989
US

IV. Provider business mailing address

5692 SILER ST
TRINITY NC
27370-8989
US

V. Phone/Fax

Practice location:
  • Phone: 585-683-0441
  • Fax:
Mailing address:
  • Phone: 585-683-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012396
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: