Provider Demographics
NPI:1609615079
Name:DAVIS, JESSIE LEE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6337
Mailing Address - Country:US
Mailing Address - Phone:601-985-7006
Mailing Address - Fax:
Practice Address - Street 1:4500 INTERSTATE 55 NORTH
Practice Address - Street 2:SUITE 208
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-292-6260
Practice Address - Fax:601-487-8115
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional