Provider Demographics
NPI:1629397740
Name:WAKEFIELD, JESSICA PSUJEK (LCMHC, NBC-HWC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PSUJEK
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LCMHC, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 CHERRY STONE LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9415
Mailing Address - Country:US
Mailing Address - Phone:919-475-6094
Mailing Address - Fax:
Practice Address - Street 1:2610 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2800
Practice Address - Country:US
Practice Address - Phone:252-816-9477
Practice Address - Fax:252-847-0819
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7297101YP2500X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional