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NPI Code Detail

MEDICARE: JESSICA LEIGH SIBOLD LPC

MEDICARE: JESSICA LEIGH SIBOLD LPC
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
1101YP2500XProfessional Counselor0701008226VA

General Provider Information

NPI Number : 1245890904
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEIGH SIBOLD LPC
Provider Business Mailing Address
First Line : 1975 ELK HILL RD
Second Line :
City : GOOCHLAND
State : VA
Zip : 23063-3318
Country : US
Telephone Number : 540-421-0992
Fax Number :
Provider Business Practice Location Address
First Line : 1975 ELK HILL RD
Second Line :
City : GOOCHLAND
State : VA
Zip : 23063-3318
Country : US
Telephone Number : 540-421-0992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2019
Last Update Date : 06/15/2019

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Directions to “ JESSICA LEIGH SIBOLD LPC” Practice Location

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