Individual
JESSE ALEXANDER WINGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
17068 LANKFORD HIGHWAY, EASTVILLE, VA 23347-2334
(757) 331-1086
Mailing address
17068 LANKFORD HIGHWAY, EASTVILLE, VA 23347
(573) 311-0867
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810007314
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/11/2019
Last updated
09/25/2024
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