Healthcare Provider Details

I. General information

NPI: 1023204377
Provider Name (Legal Business Name): JESSICA JOYCE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BUCKWALTER PKWY STE 3UV
BLUFFTON SC
29910-4132
US

IV. Provider business mailing address

102 BUCKWALTER PKWY # 3UV
BLUFFTON SC
29910-4132
US

V. Phone/Fax

Practice location:
  • Phone: 916-878-6661
  • Fax:
Mailing address:
  • Phone: 916-878-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.1621
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: