Provider Demographics
NPI:1083463905
Name:HENSLEY, JESSICA SUE (BS, CSAC-S)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:BS, CSAC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MODOC AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-3123
Mailing Address - Country:US
Mailing Address - Phone:757-439-2921
Mailing Address - Fax:
Practice Address - Street 1:1615 MODOC AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-3123
Practice Address - Country:US
Practice Address - Phone:757-439-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)