Provider Demographics
NPI:1053850891
Name:GILDEA, JESSICA (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GILDEA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CROWNPOINT EXECUTIVE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7824
Mailing Address - Country:US
Mailing Address - Phone:704-708-8314
Mailing Address - Fax:704-708-8315
Practice Address - Street 1:2301 CROWNPOINT EXECUTIVE DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7824
Practice Address - Country:US
Practice Address - Phone:704-708-8314
Practice Address - Fax:704-708-8315
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NC1-23-67156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst