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General NPI Number Information
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NPI Number | 1780089466
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Entity Type | Individual
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Provider Name | SYLVIA DIANE JESSUP LPCA, LMFTA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 5437 MCCHESNEY DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-7187
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Country | US
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Telephone | 704-572-1188
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Fax | 704-948-6254
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Provider Business Mailing Address
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Address Line | 13016 EASTFIELD RD SUITE 200-217
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6622
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Country | US
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Telephone | 701-572-1188
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Fax | 704-948-6254
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10031A
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10020A
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License Number State | NC
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