MEDICARE: JESSICA ELIZABETH WHITTINGTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCSW94934	CA
2	101YM0800X	Mental Health Counselor	CO14896	NC

General Provider Information

NPI Number	:	1003154634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ELIZABETH WHITTINGTON LCSW

Provider Business Mailing Address
First Line	:	213 LYNDEN LN
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28560-8556
Country	:	US
Telephone Number	:	209-445-4369
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 TRENT RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-2232
Country	:	US
Telephone Number	:	209-445-4369
Fax Number	:	252-634-9332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	12/16/2024

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