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NPI Code Detail

MEDICARE: JESSICA L AGNELLO LCMHC

MEDICARE: JESSICA L AGNELLO LCMHC
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 Counselor12030NC

General Provider Information

NPI Number : 1578116067
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L AGNELLO LCMHC
Provider Business Mailing Address
First Line : 9525 BIRKDALE CROSSING DR STE 300
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-8459
Country : US
Telephone Number : 704-360-3637
Fax Number :
Provider Business Practice Location Address
First Line : 9525 BIRKDALE CROSSING DR STE 300
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-8459
Country : US
Telephone Number : 704-360-3637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2019
Last Update Date : 08/14/2025

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Directions to “ JESSICA L AGNELLO LCMHC” Practice Location

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