Individual
JESSICA COVINGTON CONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 PARK RD STE 227, CHARLOTTE, NC 28209-3673
(704) 370-9405
Mailing address
4334 CASTLETON RD, CHARLOTTE, NC 28211
(704) 370-9405
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22166
NC
101YP2500X
Professional Counselor
Primary
12260
NC
101YP2500X
Professional Counselor
Primary
A12260
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12260
LPCA
NC
01
—
22166
LCASA
NC
Enumeration date
09/06/2016
Last updated
02/05/2026
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