Provider Demographics
NPI:1447925011
Name:ALDER, JESSIE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:ALDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:685 WILBURN RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37891-9138
Mailing Address - Country:US
Mailing Address - Phone:423-312-8452
Mailing Address - Fax:
Practice Address - Street 1:685 WILBURN RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:TN
Practice Address - Zip Code:37891-9138
Practice Address - Country:US
Practice Address - Phone:423-312-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical