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General NPI Number Information
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NPI Number | 1366870768
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Entity Type | Individual
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Provider Name | JESSICA MCCLEESE PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 505 S INDEPENDENCE BLVD STE 213
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-347-8807
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S INDEPENDENCE BLVD STE 213
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-761-3334
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810005219
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License Number State | VA
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