Provider Demographics
NPI:1053132720
Name:HENRY, JESSIE KNOWLES (LGSW)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:KNOWLES
Last Name:HENRY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:MISS
Other - First Name:JESSIE
Other - Middle Name:REBECCA
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 N GLEBE RD UNIT 1224
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2231
Mailing Address - Country:US
Mailing Address - Phone:757-784-6031
Mailing Address - Fax:
Practice Address - Street 1:1151 BLADENSBURG RD NE STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8971
Practice Address - Country:US
Practice Address - Phone:757-784-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083813104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker