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Individual

JESSICA LYNN BLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, NCC, LPCA, LCASA

Contact information

Practice address
1135 KILDAIRE FARM RD STE 303, CARY, NC 27511-4587
(919) 678-3817
(919) 747-4257
Mailing address
6905 RIVER RUN APT 26, RALEIGH, NC 27613-2209
(919) 271-2013

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
830000
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
23992
NC
101YM0800X
Mental Health Counselor
Primary
A13591
NC

Other

Enumeration date
06/21/2018
Last updated
06/21/2018
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