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General NPI Number Information
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NPI Number | 1275331472
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Entity Type | Individual
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Provider Name | JESSICA LAUDERDALE NCC , M. ED.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 620 E 11TH ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-3101
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Country | US
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Telephone | 423-481-9760
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Fax |
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Provider Business Mailing Address
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Address Line | 382 CHERRY ST APT 504
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City | CHATTANOOGA
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State | TN
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Zip | 37403-1021
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Country | US
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Telephone | 205-834-2590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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