Provider Demographics
NPI:1144959636
Name:COTTON, JESSICA (ALC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N FOSTER ST STE 316
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4541
Mailing Address - Country:US
Mailing Address - Phone:334-604-6993
Mailing Address - Fax:334-604-7511
Practice Address - Street 1:285 N FOSTER ST STE 316
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4541
Practice Address - Country:US
Practice Address - Phone:334-604-6993
Practice Address - Fax:334-604-7511
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3505A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health